Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis.
BACKGROUND
Perioperative central neuraxial analgesia may improve outcome after coronary artery bypass surgery due to attenuation of stress response and superior analgesia.


METHODS
MEDLINE and other databases were searched for randomized controlled trials in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass who were randomized to either general anesthesia (GA) versus general anesthesia-thoracic epidural analgesia (TEA) or general anesthesia-intrathecal analgesia (IT).


RESULTS
Fifteen trials enrolling 1178 patients were included for TEA analysis. TEA did not affect incidences of mortality (0.7% TEA vs. 0.3% GA) or myocardial infarction (2.3% TEA vs. 3.4% GA). TEA significantly reduced the risk of dysrhythmias with an odds ratio of 0.52, pulmonary complications with an odds ratio of 0.41, and time to tracheal extubation by 4.5 h and reduced analog pain scores at rest by 7.8 mm and with activity by 11.6 mm. Seventeen trials enrolling 668 patients were included for IT analysis. IT had no significant effect on incidences of mortality (0.3% IT vs. 0.6% GA), myocardial infarction (3.9% IT vs. 5.7% GA), dysrhythmias (24.8% vs. 29.1%), nausea/vomiting (31.3% vs. 28.5%), or time to tracheal extubation (10.4 h IT vs. 10.9 h GA). IT modestly decreased systemic morphine use by 11 mg and decreased pain scores by 16 mm. IT significantly increased the incidence of pruritus (10% vs. 2.5%).


CONCLUSIONS
There were no differences in the rates of mortality or myocardial infarction after coronary artery bypass grafting with central neuraxial analgesia. There were associated improvements in faster time until tracheal extubation, decreased pulmonary complications and cardiac dysrhythmias, and reduced pain scores.
Liu
Spencer S
SS
Department of Anesthesiology, Virginia Mason Medical Center and the University of Washington, Seattle, Washington 98111, USA. anessl@vmmc.org
Block
Brian M
BM
Wu
Christopher L
CL
D015360:Analgesia, Epidural; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality; D000771:Anesthesia, Intravenous; D000775:Anesthesia, Spinal; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D002490:Central Nervous System; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007278:Injections, Spinal; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D009407:Nerve Block / Q000009:adverse effects* / Q000401:mortality; D010149:Postoperative Pain / Q000453:epidemiology; D019990:Perioperative Care; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome