In patients undergoing cardiac surgery, thoracic epidural analgesia combined with general anaesthesia results in faster recovery and fewer complications but does not affect length of hospital stay.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of thoracic epidural anaesthesia (TEA) in combination with general anaesthesia during adult cardiac surgery resulted in a faster recovery, fewer complications and shorter length of hospital stay. Altogether 313 papers were identified on Medline and 368 on Embase using the reported search of which 15 represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that the use of TEA in combination with general anaesthesia results in more rapid extubation and significantly better pain relief in patients undergoing cardiac surgery. In addition, common postoperative complications such as chest infection, dysrhythmia, confusional states, renal failure and psychological sequelae may be decreased although there is currently no evidence that its use decreases length of hospital stay. Finally, whilst there are case reports of neurological injury secondary to epidural haematoma in the literature these are rare and a number of large studies have been performed confirming the safety of the technique when basic precautions regarding technical aspects of the procedure and coagulation management are followed.
Department of Cardiac Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK. alronald@tiscali.co.uk
Andrew
A
Ronald
K Anuar
KA
Abdulaziz
Thomas George
TG
Day
Martin
M
Scott