Tips from Other Journals

Regional Anesthesia Reduces Operation-Related Mortality



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2001 Jun 15;63(12):2457-2458.

Anesthesia is generally classified as general or regional. General anesthesia achieves central neurologic depression, and regional anesthesia is administered directly to block nerve input. The most common forms of regional anesthesia are neuraxial blockade of the subarachnoid space (spinal) or the epidural space surrounding the spinal fluid sac (epidural). Although there are many reasons that surgery is associated with an increased risk of mortality, it is unclear if the type of anesthesia influences this risk. Rodgers and colleagues studied the effect of general or spinal and epidural anesthesia on postoperative mortality and morbidity.

The authors searched electronic databases and the references of key publications to identify randomized, controlled trials involving spinal or epidural anesthesia. Each potential study was reviewed by two researchers, and the authors of the study were contacted to verify data, obtain any unpublished data and identify any additional studies relevant to the project. Of the 158 potential trials identified, 17 were excluded. The remaining 141 trials involved 9,559 patients randomized to general or regional anesthesia.

Within 30 days of randomization, 247 deaths were recorded. The rate of death was 2.1 percent in patients receiving epidural or spinal anesthesia and 3.1 percent in those receiving general anesthesia. This decline of one death per 100 patients in the regional anesthesia groups resulted from reductions in pulmonary embolism, cardiac events, stroke, transfusion requirements, infections and respiratory depression. No difference was demonstrated in mortality between epidural and spinal anesthesia groups, and the type or location of surgery did not influence the result. The odds of deep venous thrombosis were reduced by 44 percent, those of pneumonia by 39 percent and those of respiratory depression by 59 percent in the patients receiving neuraxial blockade. Use of epidural or spinal anesthetic halved transfusion requirements and was associated with a reduction in myocardial infarction and renal failure (see accompanying table).

Effects of Neuraxial Blockade (NB) on Postoperative Complications

Events
Complications NB (N = 4,871) No NB (N = 4,688) Odds reductions

Vascular events

Deep venous thrombosis

145

220

44% (10)

Pulmonary embolism

30

66

55% (15)

Myocardial infarction

45

59

33% (17)

Stroke

19

23

15% (29)

Bleeding

Perioperative transfusion >2 units

193

280

50% (10)

Postoperative bleeding requiring transfusion

31

69

55% (15)

Infection

Wound infection

29

33

21% (24)

Pneumonia

149

238

39% (9)

Death from other infective causes

2

10

67% (36)

Other events

Respiratory depression

26

38

59% (19)

Renal failure

18

32

43% (22)


Adapted with permission from Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1495.

Effects of Neuraxial Blockade (NB) on Postoperative Complications

View Table

Effects of Neuraxial Blockade (NB) on Postoperative Complications

Events
Complications NB (N = 4,871) No NB (N = 4,688) Odds reductions

Vascular events

Deep venous thrombosis

145

220

44% (10)

Pulmonary embolism

30

66

55% (15)

Myocardial infarction

45

59

33% (17)

Stroke

19

23

15% (29)

Bleeding

Perioperative transfusion >2 units

193

280

50% (10)

Postoperative bleeding requiring transfusion

31

69

55% (15)

Infection

Wound infection

29

33

21% (24)

Pneumonia

149

238

39% (9)

Death from other infective causes

2

10

67% (36)

Other events

Respiratory depression

26

38

59% (19)

Renal failure

18

32

43% (22)


Adapted with permission from Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1495.

The authors conclude that neuraxial blockade with spinal or epidural anesthesia significantly reduces postoperative mortality and morbidity. They call for further research to clarify the scope of the benefit and for more widespread use of regional, rather than general, anesthesia.

Rodgers A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. December 16, 2000;321:149–7.


Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article