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 .
Ketoprofen for pain after hip and knee arthroplasty.
In a double-blind , r and omized study , we have compared the effects of i.v . ketoprofen 200 mg followed by 12.5 mg h-1 over 13 h , with those of extradural morphine 4 mg in 32 patients after hip and knee arthroplasty . A visual analogue scale was used to score pain before analgesic administration ( first complaint after operation ) , 1 h after and every 2 h subsequently . Pain reduction 1 h after the start of analgesia was mean 44 % ( SEM 17 % ) in the extradural morphine group and 54 % ( 9 % ) in the ketoprofen group ( ns ) . There were no significant differences between groups in pain scores , pain reduction and additional analgesia requirement ( i.v . paracetamol ) .  Naloxone 5 micrograms kg-1 h-1 was required for hypercapnia exceeding 6.0 kPa in three patients in the extradural morphine group ( vs none in the ketoprofen group ; ns ) . There were no differences between groups in side effects , except for urinary retention , which was more frequent in the extradural morphine group ( P < 0.05 ) . As there were few differences between i.v . ketoprofen and extradural morphine , we conclude that ketoprofen may be an efficient alternative to extradural morphine after hip and knee arthroplasty
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 .