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 .
A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision.
BACKGROUND Ketamine has been shown to prolong analgesia produced by caudal local anaesthetic block and is now in common use . This study compares caudal block using bupivacaine/ketamine with dorsal nerve block of the penis . METHODS Sixty boys undergoing elective circumcision were given either 0.5 ml x kg-1 of bupivacaine 0.15 % with ketamine 0.5 mg x kg-1 ( n = 30 ) or dorsal nerve block of the penis with bupivacaine 0.5 % ( n = 30 ) as a supplement to general anaesthesia .  Postoperative pain was assessed by parents using a modified objective pain score , and the time taken to first requirement of analgesia was recorded . Motor weakness , time to first micturition , postoperative nausea and vomiting ( PONV ) , eating habits , sleep disturbance and behaviour were also assessed . RESULTS There was no difference between the groups in time to first requirement for analgesia or number of doses of paracetamol given in the first 24 h. Almost half the boys in the caudal group had motor weakness , and there was a significant increase in time to first micturition in that group . There was no difference between the groups in PONV , eating , sleeping or behavioural disturbance . CONCLUSIONS Caudal anaesthesia with bupivacaine/ketamine does not confer any advantage over a dorsal nerve block with the doses used in this study . Because of the higher incidence of side-effects and technique failure in the caudal group , dorsal nerve block is perhaps the preferred technique
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 .