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 .
Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy
A comparison was made of the effects of continuous epidural analgesia with bupivacaine and intermittent epidural morphine on  bowel function after abdominal hysterectomy . The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces . Twenty – two patients were r and omly allocated to two equal groups . An “ epidural morphine ” group received general anesthesia and epidural morphine for postoperative pain relief , and an “ epidural bupivacaine ” group was given combined general anesthesia and epidural anesthesia with 0.5 % bupivacaine intraoperatively and epidural analgesia with 0.25 % bupivacaine postoperatively . Epidural morphine or bupivacaine was given for 42 h postoperatively . Pain intensity ( visual analog scale ) was low in both groups , but lower ( P < 0.05 ) in the epidural bupivacaine group . The time to first passage of flatus was 22 16 h in the epidural bupivacaine group and 56 22 h in the epidural morphine group ( P < 0.001 ) . The time to first postoperative passage of feces was shorter ( P < 0.05 ) in the former than in the latter ( 57 44 h vs 92 22 h ) . The patients of the epidural bupivacaine group started intake of oral fluids earlier ( P<0.01 ) and to a greater extent ( P < 0.05 ) than those in the epidural morphine group . It is concluded that the duration of postoperative ileus after hysterectomy is shorter when epidural bupivacaine is given for postoperative pain relief than when this is achieved by epidural morphine
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 .