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 .
Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery
Twenty – one ASA I or II patients undergoing upper abdominal surgery were studied for 24 hours after operation . They were entered into a prospect i ve , r and omised study of patient – controlled intravenous morphine compared with continuous thoracic epidural fentanyl combined with 0.2 % bupivacaine .  Pain relief was superior in the bupivacaine series ( P < 0.05 ) throughout the 24 hour study period and this was associated with significantly greater pulmonary ventilation compared with the PCA series . Forced expiratory parameters were reduced in both series after the operation but significantly less so in the epidural group . There was a reduced incidence of emetic symptoms in the epidural group ( P < 0.05 ) but the incidence of other minor side effects did not differ significantly . Thoracic epidural fentanyl/bupivacaine results in significantly better analgesia than patient – controlled intravenous morphine
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 .