Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials.
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.
Bignami
Elena
E
Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italy.
Landoni
Giovanni
G
Biondi-Zoccai
Giuseppe G L
GG
Boroli
Filippo
F
Messina
Melissa
M
Dedola
Elisa
E
Nobile
Leda
L
Buratti
Luca
L
Sheiban
Imad
I
Zangrillo
Alberto
A
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