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 26 May 2018

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News

Epidural or spinal anaesthesia reduces major postoperative complications

Giving patients epidural or spinal anaesthesia (‘neuraxial blockade') during major surgery reduces mortality by about a third, according to research in this week's BMJ

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The team, from New Zealand, also found that the risk of serious postoperative complications in a wide range of patient groups was reduced.

Dr Anthony Rodgers and colleagues analyzed 141 trials, involving over 9500 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.

Reduction in complications by neuraxial blockade:
Deep-vein thrombosis 44%
Pulmonary embolism 55%
Transfusion 50%
Pneumonia 39%
Respiratory depression 59%

Neuraxial blockade also approximately reduced the odds of deep-vein thrombosis by 44 per cent, pulmonary embolism by 55 per cent, transfusion requirements by 50 per cent, pneumonia by 39 per cent, and respiratory depression by 59 per cent.

There were also reductions in heart attack and kidney failure.

Furthermore, the benefits did not differ by the type of surgical group or neuraxial blockade (epidural or spinal). Nor did benefits differ in trials where neuraxial blockade was combined with general anaesthesia, add the authors.

Dr Rodgers said, "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.

"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," he concluded.

BMJ 2000; 321: 1493-7
15 December 2000

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