[Combined general-epidural anesthesia compared to general anesthesia: a systematic review and meta-analysis of morbidity and mortality and analgesic efficacy in thoracoabdominal surgery].
OBJECTIVE
We performed a systematic review of randomized controlled trials to compare combined general-epidural anesthesia, followed by postoperative epidural analgesia, and general anesthesia followed by postoperative parenteral analgesia without epidural analgesia in patients undergoing thoracoabdominal surgery. Outcome measures considered were mortality, length of stay in hospital and in the intensive care unit, analgesia, and morbidity.


METHODS
We performed a systematic search of online databases (MEDLINE, EMBASE, the Cochrane Controlled Trials Registry and the metaRegister of clinical trials at http://www.controlled-trials.com/mrct/ mrct info es.asp). We also hand-searched the literature. Authors were contacted when deemed necessary.


RESULTS
A total of 30 trials (4294 patients) were analyzed. Combined anesthesia showed significant advantages in relation to 2 variables: respiratory failure (odds ratio, 0.71; 95% confidence interval [CI], 0.58 to 0.87) and analgesia on the first day after surgery (weighted mean difference, -6.91 95% CI, -9.46 to -4.36). No significant differences were found in the other variables.


CONCLUSIONS
Combined anesthesia provides better analgesia and is associated with fewer cases of postoperative respiratory failure. No significant differences were found in mortality, length of stay in hospital, or other morbidity variables.
Seller Losada
J M
JM
Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Peset, Valencia. seller_jma@gva.es
Sifre Julio
C
C
Ruiz García
V
V
D000005:Abdomen / Q000601:surgery*; D000698:Analgesia; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D019616:Thoracic Surgical Procedures / Q000401:mortality*