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 .
What Concentration of Sufentanil Should be Combined with Ropivacaine 0.2% wt/vol for Postoperative Patient-Controlled Epidural Analgesia?
In this r and omized double-blinded study , we sought to determine an optimal dose-combination of sufentanil with ropivacaine 0.2 % wt/vol as postoperative epidural analgesics . One hundred twenty patients undergoing major abdominal surgery under general and thoracic epidural anesthesia ( T9 - 11 ) were assigned to groups receiving  patient-controlled epidural analgesia with ropivacaine 0.2 % wt/vol ( R ) , ropivacaine 0.2 % wt/vol + sufentanil 0.5 & mgr;g/mL ( R+S0.5 ) , 0.75 & mgr;g/mL ( R+S0.75 ) , 1.0 & mgr;g/mL ( R+S1 ) . A visual analog score of less than 40 was considered effective , and all side effects were recorded . In r and omized subgroups ( 10 patients per group ) , plasma pharmacokinetic data were obtained for both epidural drugs . Four patients in Group R and two in Group R+S0.5 were excluded because of inadequate analgesia . The drug infusion rates ( range of means : 5.4–5.9 mL/h ) were similar in all patients . Analgesia was superior for sufentanil 0.75 & mgr;g/mL with no further enhancement by the larger sufentanil concentration of 1 & mgr;g/mL.  Sufentanil plasma levels were within the range of the minimal effective concentrations ( highest in R+S1 ) , and there was no covariation between plasma levels and pain relief . Free ropivacaine plasma concentrations remained stable for 96 h. No severe side effects were detected , although pruritus correlated with an increasing dose of sufentanil . We conclude that the combination of ropivacaine 0.2 % wt/vol and 0.75 & mgr;g/mL sufentanil provided the best analgesia with the fewest side effects of the three combinations tested . Implication s : Sufentanil is added to epidural infusions of ropivacaine 0.2 % wt/vol to improve the effectiveness of postoperative pain management . Regarding the risk of side effects , however , it is still unclear what concentration of sufentanil should be added to the local anesthetic . For postoperative thoracic epidural analgesia after major abdominal surgery , the combination of ropivacaine 0.2 % wt/vol and 0.75 & mgr;g/mL sufentanil result ed in an appropriate cost : benefit ratio between good analgesia and side effects
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 .