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 .
Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study.
We performed a prospect i ve , r and omized , double-blind study of continuous epidural analgesia for 72 hours after major abdominal procedures . Patients were r and omly assigned to one of five treatment groups : epidural morphine , epidural bupivacaine , a combination of morphine and bupivacaine , epidural saline solution , and no epidural catheter .  All patients received supplemental morphine sulfate or meperidine hydrochloride , intramuscularly or intravenously , as needed . Epidural infusion was begun at 2 to 4 ml/hr , depending on age and height , with two increments of 1 ml/hr allowed if pain relief was insufficient . All pain management decisions were made by nurses , who also monitored epidural function . Performance was measured four ways : pain as measured at regular intervals in the 72-hour period with a visual analog , pain as measured after 72 hours with the McGill Pain Question naire , amount of supplemental narcotics needed , and recovery of respiratory function and ambulation as percent of preoperative levels . The group that received the combination of morphine and bupivacaine did best on all measures ; in most instances the difference between the results seen with the combination regimen and those seen with saline solution or no catheter were significant at the 0.05 level . With the exception of pruritus , complications were evenly distributed among all treatment groups , including noncatheterized controls . We conclude that epidural analgesia with the combination of morphine and bupivacaine is safe , is easily managed , and gives pain relief superior to that provided by traditional , systemic administration of narcotics
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 .