Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

被引:1206
作者
Rodgers, A
Walker, N
Schug, S
McKee, A
Kehlet, H
van Zundert, A
Sage, D
Futter, M
Saville, G
Clark, T
MacMahon, S
机构
[1] Univ Auckland, Dept Med, Clin Trials Res Unit, Auckland, New Zealand
[2] Univ Auckland, Div Anaesthesiol, Auckland 1, New Zealand
[3] Green Lane Hosp, Dept Anaesthet, Auckland 1003, New Zealand
[4] Hvidovre Univ Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark
[5] Catharina Hosp, Dept Anesthesiol Intens Care & Pain Therapy, NL-5623 EJ Eindhoven, Netherlands
[6] Auckland Hosp, Dept Anaesthesia, Auckland, New Zealand
[7] Starship Hosp, Dept Anaesthesia, Auckland, New Zealand
[8] Royal Cornwall Hosp, Dept Anaesthesia, Treliske TR1 3LJ, Truro, England
[9] Univ Sydney, Inst Int Hlth, Sydney, NSW 1585, Australia
来源
BMJ-BRITISH MEDICAL JOURNAL | 2000年 / 321卷 / 7275期
关键词
D O I
10.1136/bmj.321.7275.1493
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality. Design Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not Studies 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists. Main outcome measures. All cause mortality. deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure. Results Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio = 0.70, 95% confidence interval 0.54 to 0.90. P = 0.006). Neuraxial blockade 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% (all P < 0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone. Conclusions Neuraxial blockade reduces postoperative mortality and other serious complications. 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. Nevertheless, these findings support more widespread use of neuraxial blockade.
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页码:1493 / 1497
页数:15
相关论文
共 202 条
[1]  
ABBOUD TK, 1985, ANESTH ANALG, V64, P996
[2]   COLLABORATIVE OVERVIEW OF RANDOMIZED TRIALS OF ANTIPLATELET THERAPY .1. PREVENTION OF DEATH, MYOCARDIAL-INFARCTION, AND STROKE BY PROLONGED ANTIPLATELET THERAPY IN VARIOUS CATEGORIES OF PATIENTS [J].
ALTMAN, R ;
CARRERAS, L ;
DIAZ, R ;
FIGUEROA, E ;
PAOLASSO, E ;
PARODI, JC ;
CADE, JF ;
DONNAN, G ;
EADIE, MJ ;
GAVAGHAN, TP ;
OSULLIVAN, EF ;
PARKIN, D ;
RENNY, JTG ;
SILAGY, C ;
VINAZZER, H ;
ZEKERT, F ;
ADRIAENSEN, H ;
BERTRANDHARDY, JM ;
BRAN, M ;
DAVID, JL ;
DRICOT, J ;
LAVENNEPARDONGE, E ;
LIMET, R ;
LOWENTHAL, A ;
MORIAU, M ;
SCHAPIRA, S ;
SMETS, P ;
SYMOENS, J ;
VERHAEGHE, R ;
VERSTRAETE, M ;
ATALLAH, A ;
BARNETT, H ;
BATISTA, R ;
BLAKELY, J ;
CAIRNS, JA ;
COTE, R ;
CROUCH, J ;
EVANS, G ;
FINDLAY, JM ;
GENT, M ;
LANGLOIS, Y ;
LECLERC, J ;
NORRIS, J ;
PINEO, GF ;
POWERS, PJ ;
ROBERTS, R ;
SCHWARTZ, L ;
SICURELLA, J ;
TAYLOR, W ;
THEROUX, P .
BMJ-BRITISH MEDICAL JOURNAL, 1994, 308 (6921) :81-100
[3]  
[Anonymous], 2020, VEGETABLES
[4]  
[Anonymous], REGIONAL ANESTHESIA
[5]   MENTAL FUNCTION IN ELDERLY MEN AFTER SURGERY DURING EPIDURAL ANALGESIA [J].
ASBJORN, J ;
JAKOBSEN, BW ;
PILEGAARD, HK ;
BLOM, L ;
OSTERGAARD, A ;
BRANDT, MR .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1989, 33 (05) :369-373
[6]   EFFECT OF EPIDURAL ANALGESIA ON METABOLIC RESPONSE TO MAJOR UPPER ABDOMINAL-SURGERY [J].
ASOH, T ;
TSUJI, H ;
SHIRASAKA, C ;
TAKEUCHI, Y .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1983, 27 (03) :233-237
[7]  
ASOH T, UNPUB POSTOPERATIVE
[8]   The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials [J].
Ballantyne, JC ;
Carr, DB ;
deFerranti, S ;
Suarez, T ;
Lau, J ;
Chalmers, TC ;
Angelillo, IF ;
Mosteller, F .
ANESTHESIA AND ANALGESIA, 1998, 86 (03) :598-612
[9]   COMBINED EPIDURAL AND GENERAL-ANESTHESIA VERSUS GENERAL-ANESTHESIA FOR ABDOMINAL AORTIC-SURGERY [J].
BARON, JF ;
BERTRAND, M ;
BARRE, E ;
GODET, G ;
MUNDLER, O ;
CORIAT, P ;
VIARS, P .
ANESTHESIOLOGY, 1991, 75 (04) :611-618
[10]  
BERGGREN D, 1987, ANESTH ANALG, V66, P497