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Outcome Studies Comparing Regional and General Anesthesia

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References

  1. Krumholz HM. Outcomes research: myths and realities. Circ Cardiovasc Qual Outcomes. 2009;2:1–3.

    Article  PubMed  Google Scholar 

  2. Clancy CM, Eisenberg JM. Outcomes research: measuring the end results of health care. Science. 1998;282:245–6.

    Article  CAS  PubMed  Google Scholar 

  3. Wu CL, Fleisher LA. Outcomes research in regional anesthesia and analgesia. Anesth Analg. 2000;91:1232–42.

    CAS  PubMed  Google Scholar 

  4. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007;104:689–702.

    Article  CAS  PubMed  Google Scholar 

  5. Popping DM, Elia N, Marret E, Remy C, Tramer MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143:990–9.

    Article  PubMed  Google Scholar 

  6. Wu CL, Rowlingson AJ, Herbert R, Richman JM, Andrews RA, Fleisher LA. Correlation of postoperative epidural analgesia on morbidity and mortality after colectomy in Medicare patients. J Clin Anesth. 2006;18:594–9.

    Article  PubMed  Google Scholar 

  7. Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, Thys DM, Santos AC. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001–7.

    Article  CAS  PubMed  Google Scholar 

  8. McCartney CJ, Brull R, Chan VW, Katz J, Abbas S, Graham B, Nova H, Rawson R, Anastakis DJ, von Schroeder H. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology. 2004;101:461–7.

    Article  PubMed  Google Scholar 

  9. Nishimori M, Ballantyne JC, Low JH. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2006; CD005059.

    Google Scholar 

  10. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev. 2005; CD004088.

    Google Scholar 

  11. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–17.

    Article  CAS  PubMed  Google Scholar 

  12. Memtsoudis SG, Liu SS. Do neuraxial techniques affect perioperative outcomes? The story of vantage points and number games. Anesth Analg. 2014;119:501–2.

    Article  PubMed  Google Scholar 

  13. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan Jr JA, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455–63.

    Article  CAS  PubMed  Google Scholar 

  14. Borovskikh NA, Lebedev LV, Strashkov VI, Vinogradov AT. [Comparative evaluation of the effectiveness of epidural anesthesia with spontaneous respiration and general anesthesia in aorto-femoral bifurcation shunt]. Vestn Khir Im I I Grek. 1990; 145: 95–8.

    Google Scholar 

  15. Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 2007;94:665–73.

    Article  CAS  PubMed  Google Scholar 

  16. Handoll HH, Madhok R, Dodds C. Anaesthesia for treating distal radial fracture in adults. Cochrane Database Syst Rev. 2002; CD003320.

    Google Scholar 

  17. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2001; CD000521.

    Google Scholar 

  18. Christopherson R, Beattie C, Frank SM, Norris EJ, Meinert CL, Gottlieb SO, Yates H, Rock P, Parker SD, Perler BA. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993;79:422–34.

    Article  CAS  PubMed  Google Scholar 

  19. Tuman KJ, McCarthy RJ, March RJ, DeLaria GA, Patel RV, Ivankovich AD. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg. 1991;73:696–704.

    Article  CAS  PubMed  Google Scholar 

  20. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kooij FO, Schlack WS, Preckel B, Hollmann MW. Does regional analgesia for major surgery improve outcome? Focus on epidural analgesia. Anesth Analg. 2014;119:740–4.

    Article  PubMed  Google Scholar 

  22. Davis FM, Laurenson VG. Spinal anaesthesia or general anaesthesia for emergency hip surgery in elderly patients. Anaesth Intensive Care. 1981;9(4):352–8.

    CAS  PubMed  Google Scholar 

  23. McKenzie PJ, Wishart HY, Smith G. Long-term outcome after repair of fractured neck of femur. Comparison of subarachnoid and general anaesthesia. Br J Anaesth. 1984;56(6):581–5.

    Article  CAS  PubMed  Google Scholar 

  24. McLaren AD, Stockwell MC, Reid VT. Anaesthetic techniques for surgical correction of fractured neck of femur. A comparative study of spinal and general anaesthesia in the elderly. Anaesthesia. 1978;33(1):10–4.

    Article  CAS  PubMed  Google Scholar 

  25. Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth. 1986;58(3):284–91.

    Article  CAS  PubMed  Google Scholar 

  26. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93:853–8.

    Article  CAS  PubMed  Google Scholar 

  27. Beattie WS, Badner NH, Choi PT. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesth Analg. 2003;97:919–20.

    Article  PubMed  Google Scholar 

  28. Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729–36.

    Article  CAS  PubMed  Google Scholar 

  29. Guay J. The benefits of adding epidural analgesia to general anesthesia: a metaanalysis. J Anesth. 2006;20:335–40.

    Article  PubMed  Google Scholar 

  30. Liu SS, Block BM, Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology. 2004;101:153–61.

    Article  CAS  PubMed  Google Scholar 

  31. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg. 2001;234:560–9.

    Article  CAS  PubMed  Google Scholar 

  32. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359:1276–82.

    Article  PubMed  Google Scholar 

  33. Svircevic V, van Hijk D, Nierich AP, Passier MP, Kalkman CJ, van der Heijden GJ, Bax L. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011;114:271–82.

    Article  CAS  PubMed  Google Scholar 

  34. Guay J, Choi PT, Suresh S, Albert N, Kopp S, Pace NL. Neuraxial anesthesia for the prevention of postoperative mortality and major morbidity: an overview of cochrane systematic reviews. Anesth Analg. 2014;119:716–25.

    Article  CAS  PubMed  Google Scholar 

  35. Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179–90.

    Article  CAS  PubMed  Google Scholar 

  36. Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;162:2053–7.

    Article  PubMed  Google Scholar 

  37. Parker M, Johansen A. Hip fracture. BMJ. 2006;333:27–30.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008;90:34–42.

    Article  PubMed  Google Scholar 

  39. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg. 2006;103:1018–25.

    Article  PubMed  Google Scholar 

  41. Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res. 2009;467:2379–402.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117:72–92.

    Article  CAS  PubMed  Google Scholar 

  43. McBrien ME, Shields MO, Heyburn G. Outcome by mode of anaesthesia for hip fracture surgery. Anaesthesia. 2014;69:640–1.

    Article  CAS  PubMed  Google Scholar 

  44. Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, Mazumdar M, Sharrock NE. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118:1046–58.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Memtsoudis SG, Rasul R, Suzuki S, Poeran J, Danninger T, Wu C, Mazumdar M, Vougioukas V. Does the impact of the type of anesthesia on outcomes differ by patient age and comorbidity burden? Reg Anesth Pain Med. 2014;39:112–9.

    Article  CAS  PubMed  Google Scholar 

  46. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857–61.

    Article  CAS  PubMed  Google Scholar 

  47. Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. Br J Anaesth. 2015;114:194–203.

    Article  CAS  PubMed  Google Scholar 

  48. McDonagh DL, Mathew JP, White WD, Phillips-Bute B, Laskowitz DT, Podgoreanu MV, Newman MF. Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury. Anesthesiology. 2010;112:852–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402.

    Article  CAS  PubMed  Google Scholar 

  50. Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110:548–55.

    Article  PubMed  Google Scholar 

  51. Chan MT, Cheng BC, Lee TM, Gin T. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33–42.

    Article  PubMed  Google Scholar 

  52. Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110(Suppl 1):i98–i105.

    Article  CAS  PubMed  Google Scholar 

  53. Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB, Mears SC. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85:18–26.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Rasmussen LS, Johnson T, Kuipers HM, Kristensen D, Siersma VD, Vila P, Jolles J, Papaioannou A, Abildstrom H, Silverstein JH, Bonal JA, Raeder J, Nielsen IK, Korttila K, Munoz L, Dodds C, Hanning CD, Moller JT. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003;47:260–6.

    Article  CAS  PubMed  Google Scholar 

  55. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22(Suppl 3):67–79.

    Article  PubMed  Google Scholar 

  56. Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology. 2007;106:572–90.

    Article  PubMed  Google Scholar 

  57. Wu CL, Hsu W, Richman JM, Raja SN. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med. 2004;29:257–68.

    Article  CAS  PubMed  Google Scholar 

  58. Heaney A, Buggy DJ. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Br J Anaesth. 2012;109(Suppl 1):i17–28.

    Article  PubMed  Google Scholar 

  59. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008;109:180–7.

    Article  PubMed  Google Scholar 

  60. Cummings III KC, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012;116:797–806.

    Article  CAS  PubMed  Google Scholar 

  61. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Scavonetto F, Yeoh TY, Umbreit EC, Weingarten TN, Gettman MT, Frank I, Boorjian SA, Karnes RJ, Schroeder DR, Rangel LJ, Hanson AC, Hofer RE, Sessler DI, Sprung J. Association between neuraxial analgesia, cancer progression, and mortality after radical prostatectomy: a large, retrospective matched cohort study. Br J Anaesth. 2014;113(Suppl 1):i95–i102.

    Article  PubMed  Google Scholar 

  63. Wuethrich PY, Hsu Schmitz SF, Kessler TM, Thalmann GN, Studer UE, Stueber F, Burkhard FC. Potential influence of the anesthetic technique used during open radical prostatectomy on prostate cancer-related outcome: a retrospective study. Anesthesiology. 2010;113:570–6.

    PubMed  Google Scholar 

  64. Day A, Smith R, Jourdan I, Fawcett W, Scott M, Rockall T. Retrospective analysis of the effect of postoperative analgesia on survival in patients after laparoscopic resection of colorectal cancer. Br J Anaesth. 2012;109:185–90.

    Article  CAS  PubMed  Google Scholar 

  65. Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, Durieux ME, Nemergut EC. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology. 2010;113:27–34.

    Article  PubMed  Google Scholar 

  66. Gottschalk A, Brodner G, Van Aken HK, Ellger B, Althaus S, Schulze HJ. Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma? Br J Anaesth. 2012;109:253–9.

    Article  CAS  PubMed  Google Scholar 

  67. Ismail H, Ho KM, Narayan K, Kondalsamy-Chennakesavan S. Effect of neuraxial anaesthesia on tumour progression in cervical cancer patients treated with brachytherapy: a retrospective cohort study. Br J Anaesth. 2010;105:145–9.

    Article  CAS  PubMed  Google Scholar 

  68. Cakmakkaya OS, Kolodzie K, Apfel CC, Pace NL. Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev. 2014; 11: CD008877.

    Google Scholar 

  69. Binczak M, Tournay E, Billard V, Rey A, Jayr C. Major abdominal surgery for cancer: does epidural analgesia have a long-term effect on recurrence-free and overall survival? Ann Fr Anesth Reanim. 2013;32:e81–8.

    Article  CAS  PubMed  Google Scholar 

  70. Christopherson R, James KE, Tableman M, Marshall P, Johnson FE. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia. Anesth Analg. 2008;107:325–32.

    Article  PubMed  Google Scholar 

  71. Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial. BMJ. 2011;342:d1491.

    Article  PubMed  Google Scholar 

  72. Tsui BC, Rashiq S, Schopflocher D, Murtha A, Broemling S, Pillay J, Finucane BT. Epidural anesthesia and cancer recurrence rates after radical prostatectomy. Can J Anaesth. 2010;57:107–12.

    Article  PubMed  Google Scholar 

  73. Buggy DJ, Borgeat A, Cata J, Doherty DG, Doornebal CW, Forget P, Gottumukkala V, Gottschalk A, Gupta A, Gupta K, Hales TG, Hemmings HC, Hollmann MW, Kurz A, Ma D, Parat MO, Sessler DI, Shorten G, Singleton P. Consensus statement from the BJA Workshop on Cancer and Anaesthesia. Br J Anaesth. 2015;114:2–3.

    Article  CAS  PubMed  Google Scholar 

  74. Hadzic A. Is regional anesthesia really better than general anesthesia? Anesth Analg. 2005;101:1631–3.

    Article  PubMed  Google Scholar 

  75. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101:1634–42.

    Article  PubMed  Google Scholar 

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Correspondence to Brian O’Donnell MB, MSc, MD, FCARCSI .

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O’Donnell, B., O’Sullivan, M. (2017). Outcome Studies Comparing Regional and General Anesthesia. In: Finucane, B., Tsui, B. (eds) Complications of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-49386-2_4

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