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 .
Effects of Intravenous Patient-Controlled Analgesia with Morphine, Continuous Epidural Analgesia, and Continuous Three-in-One Block on Postoperative Pain and Knee Rehabilitation After Unilateral Total Knee Arthroplasty
In this study , we assessed the influence of three analgesic techniques on  postoperative knee rehabilitation after total knee arthroplasty (TKA).Forty-five patients scheduled for elective TKA under general anesthesia were r and omly divided into three groups . Postoperative analgesia was provided with IV patient-controlled analgesia ( PCA ) with morphine in Group A , continuous 3-in-1 block in Group B , and epidural analgesia in Group C. Immediately after surgery , the three groups started identical physical therapy regimens . Pain scores , supplemental analgesia , side effects , degree of maximal knee flexion , day of first walk , and duration of hospital stay were recorded . Patients in Groups B and C reported significantly lower pain scores than those in Group A. Supplemental analgesia was comparable in the three groups . Compared with Groups A and C , a significantly lower incidence of side effects was noted in Group B. Significantly better knee flexion ( until 6 wk after surgery ) , faster ambulation , and shorter hospital stay were noted in Groups B and C. However , these benefits did not affect outcome at 3 mo . We conclude that , after TKA , continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than IV PCA with morphine . Because it induces fewer side effects , continuous 3-in-1 block should be considered the technique of choice . Implication s : In this study , we determined that , after total knee arthroplasty , loco-regional analgesic techniques ( epidural analgesia or continuous 3-in-1 block ) provide better pain relief and faster postoperative knee rehabilitation than IV patient-controlled analgesia with morphine . Because it causes fewer side effects than epidural analgesia , continuous 3-in-1 block is the technique of choice . ( Anesth Analg 1998;87:88 - 92
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 .