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 .
Postoperative pain and pulmonary complications: Comparison of three analgesic regimens
In a prospect i ve study , patients undergoing cholecystectomy were r and omly allocated to receive ( a ) intermittent intramuscular morphine ( n = 25 ) , ( b ) continuous intravenous morphine infusion ( n = 25 ) or ( c ) epidural bupivacaine ( n = 25 ) for postoperative pain relief . Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine ; there was no significant difference in the incidence of postoperative pulmonary complications . Patients receiving epidural bupivacaine for 12 h had better analgesia than patients receiving morphine ( P < 0.001 ) . Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days ( P < 0.05 ) . Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications ( P < 0.01 ) and chest infection ( P < 0.05 )
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 .