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Regional Anesthesia May Improve Surgical Outcomes

Although anesthesia for many surgical procedures can be achieved either with general anesthesia or with spinal or epidural regional anesthesia (also called neuraxial blockade), little evidence on outcomes exists to support the use of one approach over the other. Many studies have been performed to compare the 2 approaches, but none have been large enough to reveal significant differences, prompting this systematic review of existing trial data.

The reviewers found 141 randomized trials involving 9559 patients. Many types of surgery were included; in 60 studies, patients received both general anesthesia and neuraxial blockade. Neuraxial blockade, with or without general anesthesia, significantly reduced the odds for deep vein thrombosis (by 44 percent), pulmonary embolism (by 55 percent), transfusion requirements (by 50 percent), pneumonia (by 39 percent), and respiratory depression (by 59 percent). Mortality in the neuraxial blockade group (103 of 4871 patients) was about one third lower than in the group that received general anesthesia alone (144 of 4688). Mortality differences persisted for all types of surgery and across both types of neuraxial blockade. Mortality was not significantly lower in patients who received both general anesthesia and neuraxial blockade (OR, 0.87; 95 percent CI, 0.53-1.41) but was significantly lower in those who received neuraxial blockade alone (OR, 0.64; 95 percent CI, 0.47-0.87), compared with the general anesthesia group.

Comment: This analysis suggests that outcomes may be better when patients receive neuraxial blockade. It is unclear whether this results from simple avoidance of general anesthesia or to some additional benefit of neuraxial blockade.

— KI Marton

Published in Journal Watch General Medicine January 19, 2001

Citation(s):

Rodgers A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: Results from overview of randomised trials. BMJ 2000 Dec 16 321 1493-1497.

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