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 .
A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy.
In a prospect i ve , r and omized study , continuous infusion of epidural fentanyl citrate ( group E ) was compared with patient-controlled intravenously administered morphine sulfate ( group P ) for analgesia in 66 men after radical retropubic prostatectomy . Although both methods provided satisfactory analgesia , the mean comfort level scores were lower ( that is , greater comfort ) in group E than in group P at all observation times . The difference in mean resting comfort level scores between groups E and P was statistically significant ( P < or = 0.05 ) at 9 of the 11 observation times . In addition , significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing , 5 of 11 during coughing , and 3 of 9 during ambulation . Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower ( that is , less pain ) in group E than in group P for all four categories of activity . The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing . No significant differences were noted in side effect profiles or duration of hospital stay . In summary , when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospect ively , patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine , as evidence d by lower mean , maximal , and minimal comfort level scores and a greater proportion of patients with complete relief of pain
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 .