title: Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†.
abstract: BACKGROUND
  We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects.
  
  
  METHODS
  10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores.
  
  
  RESULTS
  Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09).
  
  
  CONCLUSIONS
  Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
authors.affiliation: Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia kate.leslie@mh.org.au.
authors.forename: K
authors.initials: K
authors.lastname: Leslie
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: McIlroy
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kasza
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Forbes
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kurz
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Khan
authors.affiliation: Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark.
authors.forename: C S
authors.initials: CS
authors.lastname: Meyhoff
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Allard
authors.affiliation: Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.affiliation: Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile.
authors.forename: X
authors.initials: X
authors.lastname: Jara
authors.affiliation: Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Lurati Buse
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA.
authors.forename: K
authors.initials: K
authors.lastname: Candiotti
authors.affiliation: Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia.
authors.forename: H-S
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, Jaipur, India.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada.
authors.forename: T
authors.initials: T
authors.lastname: VanHelder
authors.affiliation: Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India.
authors.forename: W
authors.initials: W
authors.lastname: Purayil
authors.affiliation: Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: De Hert
authors.affiliation: Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Treschan
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009407:Nerve Block / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology
keywords: anaesthesia, epidural; anaesthesia, spinal; death; myocardial infarction; stroke