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 .
Patient-controlled extradural analgesia with bupivacaine, fentanyl, or a mixture of both, after Caesarean section.
In this r and omized , double-blind study of 60 patients , we have assessed the analgesic efficacy of extradural bupivacaine and extradural fentanyl , either alone or in combination , after Caesarean section . Patients received 0.1 % bupivacaine ( group B ) , fentanyl 4 micrograms ml-1 ( group F ) or 0.05 % bupivacaine combined with fentanyl 2 micrograms ml-1 ( group BF ) by patient-controlled extradural analgesia ( PCEA ) . Adding fentanyl to bupivacaine reduced the dose of bupivacaine by up to 68 % , improved analgesia at rest and decreased PCEA use . Motor and sensory block were decreased , but there was more pruritus . Overall patient satisfaction was increased . Adding bupivacaine to fentanyl reduced the dose of fentanyl by up to 57 % without altering pain scores or PCEA use . Sensory block increased but pruritus did not decrease . Bupivacaine 0.05 % produced clinical ly significant leg weakness in three patients . Overall patient satisfaction was not altered . There was a significant additive analgesic effect between 0.05 % bupivacaine and fentanyl but no clinical benefit was demonstrated from using the combination compared with fentanyl alone for this group of postoperative patients
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 .