Combined epidural + GA + postop epidural for 72 hrs would lower the frequency of mortality and major postoperative complications within 30 days of surgery by 1/5, from 50% to 40%, compared with GA + opiods.
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High risk (morbidly obese, DM, CRF, Resp insuff, CCF, AMI, exertional angina, recent evidence myocardial ischemia, severe hepatic disease, age>75 plus 2 of ) pts undergoing elective laparotomy or thoracotomy. (not cardiac or pulmonary surgery) 900 randomised as above.
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1. Pain score on coughing day three 3.8 (GA) vs 3 (Epid + GA),
2. Respiratory failure less with epidural group NNT 15 (23% vs 30%, p=0·02)
2. Respiratory failure less with epidural group NNT 15 (23% vs 30%, p=0·02)
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