�A sketch of quarter of a million patients has shows that epidural anaesthesia anaesthesia / analgesia* (EA) is safe for patients undergoing average to speculative surgery other than cardiac surgery. However people given EA possess only a very slightly increased selection compared with those world Health Organization do not. These ar the conclusions of authors of an Article promulgated early Online and in an forthcoming edition of The Lancet.
EA offers better postoperative pain in the neck relief than intravenous opioid drugs, and also reduces the surgical stress response, which has theoretical benefits for cardiovascular, respiratory, gastrointestinal, and metabolic function. But until now one authoritative question has remained unanswered: do these benefits of EA translate into improved survival for the patients who receive it? Dr Duminda Wijeysundera, from Ontario's Institute for Clinical Evaluative Sciences, and Department of Anaesthesia, Toronto General Hospital and University of Toronto, Canada, and colleagues did a retrospective study of 259 037 Ontario patients to enquire.
The patients in the study were all of age 40 years or over, and had had selected elective intermediate to risky non-cardiac surgery between 1994 and 2004. A total of 56 556 (22%) of these patients standard EA, and the procedure was associated with a small step-down in 30-day mortality (1�7%) compared with patients wHO had non had EA (2�0%). Put another way, 477 patients had to have had EA to avert one death.
The authors conclude: "Epidural anaesthesia was associated with a small improvement in 30-day survival, just this core should be interpreted conservatively. The estimate had borderline significance, despite a large sample size of it. Its absolute magnitude was also modest, corresponding to a number needed to treat of 477. Our study, consequently, does not provide compelling evidence that epidural anaesthesia improves postoperative survival. Nonetheless, our results support the safety of perioperative epidural anesthesia anaesthesia when used for indications other than improving survival - for lesson, improving postoperative pain relief or preventing postoperative lung complications."
In an incidental Comment, Dr Michael Barrington and Dr David Scott, Department of Anaesthesia, St Vincent's Hospital, Melbourne, VIC, Australia, say: "Wijeysundera and colleagues point out that our focus should be on the proven benefits of epidural anesthesia analgesia. The most durable and understandably defined benefit of epidural anaesthesia analgesia is improved analgesia. Provision of effective analgesia is our core job: it has substantial physiological and psychological benefits, and is regarded as a fundamental human right. Pain after major surgery canful be spartan, and we think that in many cases pain relief unequaled is an unambiguous clinical indication for postoperative epidural anesthesia analgesia."
"Epidural anaesthesia and survival after intermediate-to-high risk of exposure non-cardiac surgery: a population-based cohort study"
Duminda N Wijeysundera, W Scott Beattie, Peter C Austin, Janet E Hux, Andreas Laupacis
The Lancet - Published OnlineAugust 11, 2008DOI:10.1016/S0140-6736(08)61121-6
COMMENT
"Do we need to justify epidural analgesia beyond pain relief?"
The Lancet - Published OnlineAugust 11, 2008DOI:10.1016/S0140-6736(08)61122-8
http://www.thelancet.com
More info
