| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
*Departments of Anesthesia, McMaster University, Hamilton, Ontario, Canada; and Department of Anesthesia, University of Western Ontario, London, Ontario, Canada
Address correspondence and reprint requests to W. Scott Beattie, MD, University of Toronto, Department of Anesthesia, Room 3EN357, 100 Elizabeth St., Toronto, Ontario, Canada M5G 1P5. Address e-mail to scott.beattie{at}uhn.on.ca
Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. Postoperative epidural analgesia is considered to have beneficial effects on cardiac outcomes. The use in high-risk cardiac patients remains controversial. No study has shown that postoperative epidural analgesia decreases postoperative myocardial infarction (PMI) or death. All studies are underpowered to show such a result, and the cost of conducting a large trial is prohibitive. We performed a metaanalysis to determine whether postoperative epidural analgesia continued for more than 24 h after surgery reduces PMI or in-hospital death. The available databases were searched for randomized controlled trials of epidural analgesia that was extended at least 24 h into the postoperative period. The search yielded 17 studies, of which 11 were randomized controlled trials comprising 1173 patients. Metaanalysis was conducted by using the fixed-effects model, calculating both an odds ratio and a rate difference. Postoperative epidural analgesia resulted in better analgesia for the first 24 h after surgery. The rate of PMI was 6.3%, with lower rates in the Epidural group (rate difference, -3.8%; 95% confidence interval [CI] -7.4%, -0.2%; P = 0.049). The frequency of in-hospital death was 3.3%, with no significant difference between Epidural and Nonepidural groups (rate difference, -1.3%; 95% CI, -3.8%, 1.2%, P = 0.091). Subgroup analysis of postoperative thoracic epidural analgesia showed a significant reduction in PMI in the Epidural group (rate difference, -5.3%; 95% CI, -9.9%, -0.7%; P = 0.04).
IMPLICATIONS: Postoperative epidural analgesia, especially thoracic epidural analgesia, continued for more than 24 h reduces postoperative myocardial infarctions.
This article has been cited by other articles:
|
|
 |
|
  W. H. Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, and C. W. Colwell Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 381S - 453S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Licker, J.-M. Tschopp, J. Robert, J.-G. Frey, J. Diaper, and C. Ellenberger Aerosolized Salbutamol Accelerates the Resolution of Pulmonary Edema After Lung Resection Chest, April 1, 2008; 133(4): 845 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. S. Beattie, D. N. Wijeysundera, K. Karkouti, S. McCluskey, and G. Tait Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials Anesth. Analg., April 1, 2008; 106(4): 1039 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Jaroszewski, J. Huh, D. Chu, S. C. Malaisrie, A. D. Riffel, H. S. Gordon, X. L. Wang, and F. Bakaeen Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 648 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-G. Chassot, A. Delabays, and D. R. Spahn Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Brull, C. J. L. McCartney, V. W. S. Chan, and H. El-Beheiry Neurological Complications After Regional Anesthesia: Contemporary Estimates of Risk Anesth. Analg., April 1, 2007; 104(4): 965 - 974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Liu and C. L. Wu Effect of Postoperative Analgesia on Major Postoperative Complications: A Systematic Update of the Evidence Anesth. Analg., March 1, 2007; 104(3): 689 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Licker, I. Widikker, J. Robert, J.-G. Frey, A. Spiliopoulos, C. Ellenberger, A. Schweizer, and J.-M. Tschopp Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann. Thorac. Surg., May 1, 2006; 81(5): 1830 - 1837. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Auerbach and L. Goldman Assessing and Reducing the Cardiac Risk of Noncardiac Surgery Circulation, March 14, 2006; 113(10): 1361 - 1376. [Full Text] [PDF]
|
|
|
|
|
|
P. E. Macintyre, S. Walker, I. Power, and S. A. Schug Editorial I: Acute pain management: scientific evidence revisited Br. J. Anaesth., January 1, 2006; 96(1): 1 - 4. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Bainbridge, D. C. Cheng, J. E. Martin, R. Novick, and The Evidence-Based Perioperative Clinical Outcomes NSAID-analgesia, pain control and morbidity in cardiothoracic surgery: [L'analgesie avec des AINS, le controle de la douleur et la morbidite en chirurgie cardiothoracique] Can J Anesth, January 1, 2006; 53(1): 46 - 59. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. S. Beattie, E. Abdelnaem, D. N. Wijeysundera, and D. N. Buckley A Meta-Analytic Comparison of Preoperative Stress Echocardiography and Nuclear Scintigraphy Imaging Anesth. Analg., January 1, 2006; 102(1): 8 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Chaney Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery Anesth. Analg., January 1, 2006; 102(1): 45 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Viscusi Emerging Techniques in the Management of Acute Pain: Epidural Analgesia Anesth. Analg., November 1, 2005; 101(5S_Suppl): S23 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Chaney Cardiac surgery and intrathecal/epidural techniques: at the crossroads?/Cardiochirurgie et techniques intrathecale/peridurale : sommesnous a la croisee des chemins? Can J Anesth, October 1, 2005; 52(8): 783 - 788. [Full Text] [PDF]
|
|
|
|
|
|
S. Suttner, K. Lang, S. N. Piper, H. Schultz, K. D. Rohm, and J. Boldt Continuous Intra- and Postoperative Thoracic Epidural Analgesia Attenuates Brain Natriuretic Peptide Release After Major Abdominal Surgery Anesth. Analg., September 1, 2005; 101(3): 896 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. S. Beattie Evidence-based perioperative risk reduction Can J Anesth, June 1, 2005; 52(suppl_1): R5 - R5. [Full Text] [PDF]
|
|
|
|
|
|
J. C. Rowlingson and P. B. Hanson Neuraxial Anesthesia and Low-Molecular-Weight Heparin Prophylaxis in Major Orthopedic Surgery in the Wake of the Latest American Society of Regional Anesthesia Guidelines Anesth. Analg., May 1, 2005; 100(5): 1482 - 1488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. B. Foss and H. Kehlet Mortality analysis in hip fracture patients: implications for design of future outcome trials Br. J. Anaesth., January 1, 2005; 94(1): 24 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Freise, S. Anthonsen, L. G. Fischer, H. K. Van Aken, and A. W. Sielenkamper Continuous Thoracic Epidural Anesthesia Induces Segmental Sympathetic Block in the Awake Rat Anesth. Analg., January 1, 2005; 100(1): 255 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. H. Geerts, G. F. Pineo, J. A. Heit, D. Bergqvist, M. R. Lassen, C. W. Colwell, and J. G. Ray Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 338S - 400S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zaugg, C. Schulz, J. Wacker, and M. C. Schaub Sympatho-modulatory therapies in perioperative medicine Br. J. Anaesth., July 1, 2004; 93(1): 53 - 62. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M Nimmo Benefit and outcome after epidural analgesia CEACCP, April 1, 2004; 4(2): 44 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Ballantyne Editorial II: Does epidural analgesia improve surgical outcome? Br. J. Anaesth., January 1, 2004; 92(1): 4 - 6. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Berendes, C. Schmidt, H. Van Aken, M. G. Hartlage, S. Wirtz, H. Reinecke, M. Rothenburger, H. H. Scheld, B. Schluter, G. Brodner, et al. Reversible Cardiac Sympathectomy by High Thoracic Epidural Anesthesia Improves Regional Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Trial Arch Surg, December 1, 2003; 138(12): 1283 - 1290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Block, S. S. Liu, A. J. Rowlingson, A. R. Cowan, J. A. Cowan Jr, and C. L. Wu Efficacy of Postoperative Epidural Analgesia: A Meta-analysis JAMA, November 12, 2003; 290(18): 2455 - 2463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. S. Beattie, N. H. Badner, and P. T-L. Choi Meta-Analysis Demonstrates Statistically Significant Reduction in Postoperative Myocardial Infarction with the Use of Thoracic Epidural Analgesia Anesth. Analg., September 1, 2003; 97(3): 919 - 920. [Full Text] [PDF]
|
|
|
|
|
|
R. Charghi, S. Backman, N. Christou, F. Rouah, and T. Schricker Patient controlled iv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia: [L'analgesie iv autocontrolee est une strategie de traitement de la douleur acceptable chez les patients atteints d'obesite morbide qui subissent un pontage gastrique. Une comparaison retrospective avec l'analgesie peridurale] Can J Anesth, August 1, 2003; 50(7): 672 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-H. Fleron, R. B. Weiskopf, M. Bertrand, S. Mouren, D. Eyraud, G. Godet, B. Riou, E. Kieffer, and P. Coriat A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular, Respiratory, and Renal Complications After Abdominal Aortic Surgery Anesth. Analg., July 1, 2003; 97(1): 2 - 12. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ganapathy, C. J.L. McCartney, W. S. Beattie, and V. W.S. Chan Best evidence in anesthetic practice: Prevention: epidural anesthesia and analgesia does not reduce 30-day all-cause mortality and major morbidity after abdominal surgery Can J Anesth, February 1, 2003; 50(2): 143 - 146. [Full Text] [PDF]
|
|
|
|
|
|
O. A. de Leon-Casasola When It Comes to Outcome, We Need to Define What a Perioperative Epidural Technique Is Anesth. Analg., February 1, 2003; 96(2): 315 - 318. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Peyton, P. S. Myles, B. S. Silbert, J. A. Rigg, K. Jamrozik, and a. R. Parsons Perioperative Epidural Analgesia and Outcome After Major Abdominal Surgery in High-Risk Patients Anesth. Analg., February 1, 2003; 96(2): 548 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Royse, A. Royse, P. Soeding, D. Blake, and J. Pang Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery Ann. Thorac. Surg., January 1, 2003; 75(1): 93 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-G. Chassot, A. Delabays, and D. R. Spahn Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery Br. J. Anaesth., November 1, 2002; 89(5): 747 - 759. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. U. Werner, L. Soholm, P. Rotboll-Nielsen, and H. Kehlet Does an Acute Pain Service Improve Postoperative Outcome? Anesth. Analg., November 1, 2002; 95(5): 1361 - 1372. [Full Text] [PDF]
|
|
|
