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 .
Epidural analgesia in colonic surgery: Results of a randomized prospective study
Colonic surgery patients were studied to measure : the influence of continuous thoracic epidural analgesia ( TEA ) on a postoperative pain score , the time till onset of defaecation , blood loss , postoperative temperature elevations , rate of bacterial contamination of wounds and urine , and general surgical complications .  Group I patients ( n = 57 ) received general anaesthesia and TEA for the operation , followed by continuous TEA ( 0·25 per cent bupivacaine ) for 72 h.  Group II patients ( n = 59 ) received general anaesthesia for the operation , followed by systemic analgesia on request . Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation . However , there were fewer temperature elevations in group II . There was no significant difference between the groups in terms of positive bacteriological cultures , blood loss , need for postoperative mechanical ventilation and complications . However , there was a trend toward a higher rate of rectal anastomotic breakdown , increased blood replacement and intensive care therapy , and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen . In selected patients ( i.e. those with severe pain or those prone to develop postoperative ileus ) continuous TEA may be beneficial
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 .