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 .
Postoperative Epidural Morphine, but not Epidural Bupivacaine, Delays Gastric Emptying on the First Day after Cholecystectomy
Background and Objectives . Gastric emptying is delayed during the first days after abdominal surgery . Studies with volunteers have shown that epidural morphine delays gastric emptying but epidural analgesia with bupivacaine does not . The aim of this study was to evaluate whether these differences in healthy volunteers are also found after cholecystectomy when epidural morphine or epidural bupivacaine is used for postoperative pain relief . Methods . Eighteen healthy patients were r and omly allocated into two groups . Nine patients received postoperative analgesia with epidural morphine  and nine with  thoracic epidural bupivacaine .  Acetaminophen absorption was used as an indirect measure of the rate of gastric emptying , measured 22 hours after surgery and again 4 weeks later , so that each patient served as their own control . During epidural morphine , serum acetaminophen concentrations were lower , and the area under the concentration time curve from 0 to 60 minutes ( AUC60 ) was smaller ( p < 0.02 ) , the maximum serum acetaminophen concentration ( Cmax ) was lower ( p < 0.05 ) , and the time taken to reach the maximum concentration ( Tmax ) was longer ( p < 0.01 ) compared to epidural bupivacaine . There were no statistically significant differences in AUC60 , Cmax , and Tmax between the two groups during the control study . Conclusions . Postoperative gastric emptying was significantly delayed after epidural analgesia with morphine compared to thoracic epidural bupivacaine . Compared to the control situation , epidural bupivacaine did not influence gastric emptying
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 .