WESTPORT, CT (Reuters Health) - Neuraxial blockade, using epidural or spinal anesthesia, reduces postoperative complications and mortality, according to a report published in the December 16th issue of the British Medical Journal.

However, further research is needed to determine if the blockade alone causes these beneficial effects or if the lack of general anesthesia is partly responsible, the authors point out.

Dr. Anthony Rodgers, from the University of Auckland in New Zealand, and colleagues reviewed data from 141 anesthesia trials with 9559 patients to determine the impact of neuraxial blockade on postoperative morbidity and mortality.

Overall, the authors found that mortality was reduced by about one third in patients who received neuraxial blockade compared with those who did not. Further, neuraxial blockade also significantly reduced the odds of deep vein thrombosis, pulmonary embolism, transfusion requirements, pneumonia, and respiratory depression. Myocardial infarction and renal failure were also reduced.

On subgroup analysis, the investigators found no difference in mortality based on surgical group, type of blockade, or if neuraxial blockade was combined with general anesthesia. The researchers admit, however, that the power to assess these associations was limited.

"The benefits seen for neuraxial blockade may be conferred by multifactorial mechanisms, including altered coagulation, increased blood flow, improved ability to breathe free of pain, and reduction in surgical stress responses," Dr. Rodger's team postulates.

The ability to reduce a stress response, "together with the subgroup comparisons shown here, suggests that these benefits are principally due to the use of neuraxial blockade rather than avoidance of general anesthesia," the investigators state.

"If the proportional effects of neuraxial blockade are consistent in different patient populations, neuraxial blockade would be expected to result in about one fewer postoperative death and several fewer major complications for every 100 patients at similar risk in the studies," the researchers estimate. Prior studies have not had enough statistical power to show a benefit from blockade, they add.

Although clinicians may remain uncertain about the net benefits of neuraxial blockade and proper patient selection, Dr. Rodger's team believes that these findings "should result in more widespread use of spinal or epidural anesthesia."

(From Reuters)