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Review: epidural or spinal anaesthesia reduces post-operative mortality and morbidity

Data sources
Studies were identified by searching Medline (1966–96), Current Contents (1995–6), EMBASE/Excerpta Medica (1980–96), and the Cochrane Library (1998) with terms that include regional anaesthesia, spinal, and epidural. In addition, conference proceedings were hand searched, bibliographies of relevant papers were scanned, and authors were contacted.

Study selection
Studies were selected if they were randomised trials of epidural or spinal anaesthesia compared with general anaesthesia and if data were available before January 1, 1997.

Data extraction
Data were extracted on study characteristics, including type of surgery, patient numbers, type of neuraxial blockade used, and outcomes.

Main results
158 studies were identified, and 141 studies (9559 patients, 4871 who received epidural or spinal anaesthesia and 4688 who did not) met the selection criteria. Studies represented various surgical groups: general surgery (n=28), orthopaedics (n=44), urology (n=18), vascular (n=22), and other (n=29). 247 deaths that occurred within 30 days of randomisation were reported in 35 trials. Epidural or spinal anaesthesia reduced . . . [Full text of this article]

Peter J Pronovost, MD, PhD

Johns Hopkins University Baltimore, Maryland, USA