Epidural analgesia for cardiac surgery

Area of Science:

• Anesthesiology
• Cardiothoracic Surgery
• Critical Care Medicine

Background:

• General anesthesia (GA) combined with thoracic epidural analgesia (TEA) may improve outcomes in cardiac surgery by reducing perioperative complications.
• The efficacy of TEA in conjunction with GA for cardiac surgery requires further investigation.

Purpose of the Study:

• To evaluate the impact of perioperative epidural analgesia in cardiac surgery on mortality and cardiac, pulmonary, and neurological morbidity.
• To compare the risks of adverse events and mortality in patients undergoing cardiac surgery with GA alone versus GA plus TEA through a meta-analysis.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, CINHAL, Science Citation Index) up to November 2012.
• Randomized controlled trials comparing adult patients undergoing cardiac surgery with GA alone or GA plus TEA were included.
• Data from 31 publications involving 3047 patients (1578 with GA, 1469 with GA plus TEA) were analyzed.

Main Results:

• Compared to GA alone, GA with TEA showed a reduced risk ratio (RR) for respiratory complications (0.68) and supraventricular arrhythmias (0.65).
• No significant differences were observed in mortality (RR 0.84), myocardial infarction (RR 0.76), or stroke (RR 0.50) between the two groups.
• The meta-analysis included data from 31 studies comprising 3047 patients.

Conclusions:

• The use of TEA in patients undergoing coronary artery bypass graft surgery may decrease the risk of postoperative supraventricular arrhythmias and respiratory complications.
• This meta-analysis found no significant effect of TEA combined with GA on mortality, myocardial infarction, or neurological complications compared to GA alone.