title: Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials.
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.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Hospitals.
  
  
  METHODS
  A total of 2366 patients from 33 randomized trials.
  
  
  METHODS
  None.
  
  
  RESULTS
  
  
  
  METHODS
  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.
authors.affiliation: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Filippo
authors.initials: F
authors.lastname: Boroli
authors.forename: Melissa
authors.initials: M
authors.lastname: Messina
authors.forename: Elisa
authors.initials: E
authors.lastname: Dedola
authors.forename: Leda
authors.initials: L
authors.lastname: Nobile
authors.forename: Luca
authors.initials: L
authors.lastname: Buratti
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods / Q000639:trends*; D000768:Anesthesia, General / Q000379:methods / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000639:trends*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends; D016896:Treatment Outcome