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 .
[Patient-controlled postoperative analgesia in orthopedic surgery: epidural PCA versus intravenous PCA].
OBJECTIVE To evaluate both effectiveness and incidence of side effects of two techniques of postoperative pain treatment : intravenous and epidural PCA . DESIGN Prospect i ve analysis of data from two groups of r and omized patients . SETTING S Orthopedic and trauma center . PATIENTS Figty ASA class II-III patients undergoing total hip replacement under combined Spinal-Epidural Anesthesia . METHODS Patients were divided into 2 groups who received different postoperative pain treatment . One group ( group PCA ) received a patient-controlled intravenous analgesia with morphine 30 mg and ketorolac 90 mg in 100 ml of saline ( back-ground infusion 2 - 4 ml , according to body weith , bolus 1 ml , lockout 5 min , 4 h dose limit 40 ml ) . PCEA group received a patient-controlled epidural analgesia with morphine 4 mg and bupivacaine 0.125 % 100 ml , ( background infusion 3 - 4 ml , according to patient ' height , bolus 1 ml , lockout 10 min , 4 h dose limit 25 ml ) . Postoperative pain intensity was evaluated , through 24 postoperative hours , by a verbal analogue scale ( VPS = 0 to 3 ) and a total pain score ( TOTPAR ) was calculated for each patient at 6 and 24 postoperative hours . Side effects were recorded and their incidence was obtained for each group . Statistical data analysis was performed by one-way ANOVA and non-parametric tests for ordinal data . Nominal data were analyzed by chi 2 test . p < 0.05 was considered significant . RESULTS Patient receiving PCEA showed a significant ( p < 0.005 ) decrease of incident pain , while VPS at rest was similar in the two groups . TOTPAR VPS was lower ( p < 0.05 ) in PCEA group both at 6 and 24 postoperative hours . Somnolence was observed more often in PCA patients ( 8 % vs 2 % ; p 0.05 ) , while no significant differences were noted among other side effects incidence . CONCLUSIONS Our data show a better control of postoperative pain arising from total hip replacement during PCEA when compared to PCA . It should be emphasized that incident pain is far more decreased by PCEA , so that this technique is particularly indicated when an early postoperative mobilization is required
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 .