Reduction in postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials
Giving patients epidural or spinal anaesthesia (known as neuraxial blockade) during major surgery reduces mortality by about a third and also reduces the risk of serious postoperative complications in a wide range of patient groups, finds a study in this week's BMJ.
Rodgers and colleagues analysed 141 trials, involving over 9,500 patients, to provide more reliable estimates of the effects of neuraxial blockade. In patients receiving neuraxial blockade, overall mortality was reduced by about a third. Neuraxial blockade also approximately reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59%. There were also reductions in heart attack and kidney failure. Furthermore, the benefits did not differ by the type of surgical group, the type of neuraxial blockade (epidural or spinal), or in trials where neuraxial blockade was combined with general anaesthesia, add the authors.
The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia, say the authors. However, given that the risks of fatal or life threatening events are increased several fold after major surgery, these findings support more widespread use of neuraxial blockade, they conclude.
Contacts:
Anthony Rodgers, Clinical Trials Research Unit, Division of Medicine, The University of Auckland, New Zealand
Email: a.rodgers@ctru.aukland.ac.nz
OR
Stephen Schug, Division of Anaesthesiology, The University of Auckland, New Zealand
Email: s.schug@auckland.ac.nz