Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews

• Published in: Cochrane database of systematic reviews 2014-01, Vol.2014 (1), p.CD010108-CD010108
• Main Authors: Guay, Joanne, Choi, Peter, Suresh, Santhanam, Albert, Natalie, Kopp, Sandra, Pace, Nathan Leon
• Format: Article
• Language: English
• Subjects: Anesthesia, Epidural - adverse effects; Anesthesia, Epidural - methods; Anesthesia, General - adverse effects; Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - methods; Child health; Heart Arrest - prevention & control; Humans; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Pain & anaesthesia; Pneumonia - mortality; Pneumonia - prevention & control; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Regional anaesthesia; Review Literature as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010108.pub2

Various beneficial effects derived from neuraxial blocks have been reported. However, it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications. Our primary objective was to summarize Cochrane systematic reviews that assess the effects of neuraxial blockade on perioperative rates of death, chest infection and myocardial infarction by integrating the evidence from all such reviews that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various populations. Our secondary objective was to summarize the evidence on adverse effects (an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility) of neuraxial blockade. Within the reviews, studies were selected using the same criteria. A search was performed in the Cochrane Database of Systematic Reviews on July 13, 2012. We have (1) included all Cochrane systematic reviews that examined participants of any age undergoing any type of surgical (open or endoscopic) procedure, (2) compared neuraxial blockade versus general anaesthesia alone for surgical anaesthesia or neuraxial blockade plus general anaesthesia versus general anaesthesia alone for surgical anaesthesia and (3) included death, chest infection, myocardial infarction and/or serious adverse events as outcomes. Neuraxial blockade could consist of epidural, caudal, spinal or combined spinal-epidural techniques administered as a bolus or by continuous infusion. Studies included in these reviews were selected on the basis of the same criteria. Reviews and studies were selected independently by two review authors, who independently performed data extraction when data differed from one of the selected reviews. Data were analysed by using Review Manager Version 5.1 and Comprehensive Meta Analysis Version 2.2.044. Nine Cochrane reviews were selected for this overview. Their scores on the Overview Quality Assessment Questionnaire varied from four to six of a maximal possible score of seven. Compared with general anaesthesia, neuraxial blockade reduced the zero to 30-day mortality (risk ratio [RR] 0.71, 95% confidence interval [CI] 0.53 to 0.94; I(2) = 0%) based on 20 studies that included 3006 participants. Neuraxial blockade also decreased the risk of pneumonia (RR 0.45, 95% CI 0.26 to 0.79; I(2) = 0%) based on five studies that included 400 participa