Bignami E, Landoni G, Biondi-Zoccai GGL, Boroli F, Messina M, Dedola E, Nobile L, Buratti L, Sheiban I, Zangrillo A. Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials.
J Cardiothorac Vasc Anesth 2009;
24:586-97. [PMID:
20005129 DOI:
10.1053/j.jvca.2009.09.015]
[Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE
The authors conducted a review of randomized studies to determine whether there were any advantages for clinically relevant outcomes by adding epidural analgesia in patients undergoing cardiac surgery under general anesthesia.
DESIGN
Meta-analysis.
SETTING
Hospitals.
PARTICIPANTS
A total of 2366 patients from 33 randomized trials.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
DATA SOURCES AND STUDY SELECTION
PubMed, BioMedCentral, CENTRAL, EMBASE, Cochrane Central Register of Controlled Trials, and conference proceedings were searched (updated January 2008) for randomized trials that compared general anesthesia with an anesthetic plan including general anesthesia and epidural analgesia in cardiac surgery. Two independent reviewers appraised study quality, with divergences resolved by consensus. Overall analysis showed that epidural analgesia reduced the risk of the composite endpoint mortality and myocardial infarction (30/1125 [2.7%] in the epidural group v 64/1241 [5.2%] in the control arm, odds ratio [OR] = 0.61 [0.40-0.95], p = 0.03 number needed to treat [NNT] = 40), the risk of acute renal failure (35/590 [5.9%] in the epidural group v 54/618 [8.7%] in the control arm, OR = 0.56 [0.34-0.93], p = 0.02, NNT = 36), and the time of mechanical ventilation (weighted mean differences = -2.48 hours [-2.64, -2.32], p < 0.001).
CONCLUSIONS
This analysis suggested that epidural analgesia on top of general anesthesia reduced the incidence of perioperative acute renal failure, the time on mechanical ventilation, and the composite endpoint of mortality and myocardial infarction in patients undergoing cardiac surgery.
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