Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†.

BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. RESULTS: Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09). CONCLUSIONS: Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.

A comparison of the head and cervical posture between the self-balanced position and the Frankfurt method.

Head and cervical posture evaluation has been a concern for many years, not only because of the purported relationship that exists between head and cervical posture in the presence of temporomandibular disorders, neck pain and headache, but also because of the biomechanical relationship between the head and cervical spine and dentofacial structures. Many methods have been suggested in an attempt to establish the best way to evaluate the position of the head using teleradiographs and cephalometric analysis. However, there is still no agreement as to which procedure is the best. The objective of this study was to evaluate the differences that exist between craniocervical measurements in lateral teleradiographs when comparing the position of the head in the self-balanced position to the position of the head using the Frankfurt method (Frankfurt plane parallel to the floor). Sixty-eight subjects who sought dental treatment in community health centres in Talca, Chile participated in this study. Rocabado analysis was used to measure the craniocervical variables. The Cobb analysis was used to measure cervical lordosis. A paired student t-test was used to evaluate the differences between both procedures, using an alpha of 0.05 and a power of 0.90. The use of the cephalostat changed only the craniocervical angle (P < 0.001). However, this change was minimal. No changes related to gender and age were found. More studies are needed to determine the variation between different procedures and to define a good procedure for evaluating head posture.