“…175,[181][182][183][184][185][186][187][188][189][190][191] The most recent and comprehensive meta-analysis included 69 RCTs (4,860 patients overall) in which epidural analgesia was compared with either intravenous analgesia, peripheral nerve block, intrapleural analgesia, or wound infiltration in adult patients undergoing any cardiac surgery. 191 Among studies using systemic analgesia as a comparator, no differences were found between arms in up to 30day mortality (3,418 patients from 38 RCTs; risk difference [RD] 0.00, 95% CI À0.01 to 0.01) and in the incidence of postoperative stroke (2,232 patients from 18 RCTs; RD À0.00, 95% CI À0.01 to 0.01), and no or little difference was found in the risk of postoperative pneumonia (1,107 patients from 10 RCTs; RD À0.03, 95% CI À0.07 to 0.01). Conversely, epidural analgesia was found to be associated with reduced rates of PMI (2,713 patients from 26 RCTs; RD À0.01, 95% CI À0.02 to 0.00), respiratory depression (1,736 patients from 21 RCTs; RD À0.03, 95% CI À0.05 to À0.01), and atrial fibrillation or flutter (2,431 patients from 18 RCTs; RD À0.06, 95% CI À0.10 to À0.01); reduced (by about 2.4 h) times to tracheal extubation (3,353 patients from 40 RCTs; standardized mean difference À0.78, 95% CI À1.01 to À0.55); and improved pain control up to 72 hours after surgery.…”