Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012), PubMed (1966 to November 2012), Lilacs (1982 to November 2012), SciELO, EMBASE (1974 to November 2012) and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.

研究背景与目的：以死亡率作为结局指标时，骨科手术中椎管内麻醉（neuraxial anesthesia）的获益效果仍存在争议。本研究旨在对比骨科手术中椎管内麻醉与全身麻醉（general anesthesia）的有效性与安全性。
研究设计与实施地点：于阿拉戈斯联邦大学（Universidade Federal de Alagoas）开展的系统综述。
研究方法：本研究检索了Cochrane对照试验中心注册库（2012年第10期）、PubMed（1966年至2012年11月）、Lilacs数据库（1982年至2012年11月）、SciELO数据库、EMBASE数据库（1974年至2012年11月）以及纳入研究的参考文献列表。仅纳入随机对照试验（randomized controlled trial, RCT）。
研究结果：在5032篇题名与摘要中，最终纳入17项研究。死亡率（风险差（risk difference, RD）：-0.01；95%置信区间（confidence interval, CI）：-0.04至0.01；n=1903）、脑卒中（RD：0.02；95%CI：-0.04至0.08；n=259）、心肌梗死（RD：-0.01；95%CI：-0.04至0.02；n=291）、住院时长（均差（mean difference）：-0.05；95%CI：-0.69至0.58；n=870）、术后认知功能障碍（RD：0.00；95%CI：-0.04至0.05；n=479）及肺炎（优势比（odds ratio, OR）：0.61；95%CI：0.25至1.49；n=167）均未观察到统计学显著差异。
研究结论：截至目前，纳入研究的现有证据尚不足以证实骨科手术中椎管内麻醉的有效性与安全性优于全身麻醉。但本系统综述并未排除死亡率、脑卒中、心肌梗死、住院时长、术后认知功能障碍及肺炎存在临床重要差异的可能性。