脊髓和硬膜外麻醉和镇痛是所有麻醉师都熟悉的重要麻醉技术，适用于接受一系列外科手术的患者。尽管在临床实践中很容易观察到良好实施的椎管内技术对伤害性和交感神经通路的直接影响，但此类技术对以患者为中心的围手术期结果的影响仍然是一个不确定和活跃的研究领域。本综述的目的是对最近 5 年期间有关该主题的当代临床科学进行叙述性综合，并总结本研究所依据的基础学术成果。我们检索了电子数据库中的初级研究、二级研究、观点文章和指南，报告 2018-2023 年期间椎管内手术与标准化围手术期结果之间的关系。对返回的引文列表进行了检查，寻求更多研究，以将我们对结果的叙述性综合结合起来。检索到的文章涵盖以下结果领域：患者舒适度、肾脏、脓毒症和感染、术后癌症、心血管、肺部和死亡率结果。令人信服的证据表明，硬膜外镇痛对大型开胸腹手术结果后患者的舒适度有益。最近的证据表明，该药物在预防肺部并发症和死亡率方面具有益处。尽管有机械合理性和支持性观察证据，但支持神经轴技术影响其他结果领域的作用的实验证据较少。椎管内技术积极影响的证据最好是在患者舒适度、肺部并发症和死亡率方面，特别是在大型开腹手术中。最近的证据并不强烈支持椎管内技术对大多数患者群体非心脏手术后的癌症、肾脏、感染或心血管结局的显着影响。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

Spinal and epidural anaesthesia and analgesia are important anaesthetic techniques, familiar to all anaesthetists and applied to patients undergoing a range of surgical procedures. Although the immediate effects of a well-conducted neuraxial technique on nociceptive and sympathetic pathways are readily observable in clinical practice, the impact of such techniques on patient-centred perioperative outcomes remains an area of uncertainty and active research. The aim of this review is to present a narrative synthesis of contemporary clinical science on this topic from the most recent 5-year period and summarise the foundational scholarship upon which this research was based. We searched electronic databases for primary research, secondary research, opinion pieces, and guidelines reporting the relationship between neuraxial procedures and standardised perioperative outcomes over the period 2018-2023. Returned citation lists were examined seeking additional studies to contextualise our narrative synthesis of results. Articles were retrieved encompassing the following outcome domains: patient comfort, renal, sepsis and infection, postoperative cancer, cardiovascular, and pulmonary and mortality outcomes. Convincing evidence of the beneficial effect of epidural analgesia on patient comfort after major open thoracoabdominal surgery outcomes was identified. Recent evidence of benefit in the prevention of pulmonary complications and mortality was identified. Despite mechanistic plausibility and supportive observational evidence, there is less certain experimental evidence to support a role for neuraxial techniques impacting on other outcome domains. Evidence of positive impact of neuraxial techniques is best established for the domains of patient comfort, pulmonary complications, and mortality, particularly in the setting of major open thoracoabdominal surgery. Recent evidence does not strongly support a significant impact of neuraxial techniques on cancer, renal, infection, or cardiovascular outcomes after noncardiac surgery in most patient groups.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.