Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
Extradural and parenteral pethidine as analgesia after total hip replacement: Effects and kinetics. A controlled clinical study
Summary Twenty-one patients who had undergone total hip replacement were r and omly assigned to one of three groups in order to compare a single dose of 1 mg/kg of pethidine i m ( I ) and 20 mg ( II ) or 60 mg of extradural pethidine ( III ) in a double-blind design .The degree of analgesia , the adverse effects , and the kinetics were studied for 18 h. Pain was monitored using a visual analogue scale ( VAS ) . Supplementary doses of oxycodone if required were given no earlier than 0.75 h after pethidine . Plasma concentrations of pethidine  were measured with gas chromatography mass spectrometry ( GCMS ) . Hypoalgesia to pin prick test was evaluated . Low pain scores were observed in the extradural groups between 0.25 and 1.5 h after the dose . A significant difference in pain score compared with the i m group was found after the higher extradural dose only between 0.5 and 1 h (p<0.05).The area under the curve ( AUC ) of pain score versus time ( 0–18 h ) was not significantly different between groups . The recorded adverse effects were minor in all three groups . The terminal half-lives and plasma clearances of pethidine , and the time to peak concentration were not different between the groups . Single patients in the extradural groups showed hypoalgesia to pin prick in parallel to the effect . The present study shows that extradural pethidine produces shortlived analgesia , in contrast to the long-lasting effect of morphine found in other studies
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .