Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials

Abstract

To assess the efficacy of thoracic epidural anesthesia (TEA) with or without general anesthesia (GA) versus GA in patients who underwent cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of Science were searched with the limit of randomized controlled trials (RCTs) relevant to ‘thoracic epidural anesthesia’ and ‘cardiac surgery’. Studies were identified and data were extracted by two reviewers independently. The quality of included studies was also assessed according to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory functions, and treatment-associated complications were pooled and analyzed. The comprehensive search yielded 2,230 citations, and 25 of them enrolling 3,062 participants were included according to the inclusion criteria. Compared with GA alone, patients received TEA and GA showed reduced risks of death, myocardial infarction, and stroke, though there were no significant differences (P > 0.05). With regard to treatment-related complications, the pooled results for respiratory complications (risk ratio (RR), 0.69; 95% CI: 0.51, 0.91, P < 0.05), supraventricular arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P < 0.05), and pain (mean difference (MD), −1.27; 95% CI: −2.20, −0.35, P < 0.05) were 0.69, 0.61, and −1.27, respectively. TEA was also associated with significant reduction of stays in intensive care unit (MD, −2.36; 95% CI: −4.20, −0.52, P < 0.05) and hospital (MD, −1.51; 95% CI: −3.03, 0.02, P > 0.05) and time to tracheal extubation (MD, −2.06; 95% CI:−2.68, −1.45, P < 0.05). TEA could reduce the risk of complications such as supraventricular arrhythmias, stays in hospital or intensive care unit, and time to tracheal extubation in patients who experienced cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s40001-015-0091-y) contains supplementary material, which is available to authorized users.

Chronic Poststernotomy Pain

“…[100][101][102] Thoracic Epidural Anesthesia Thoracic epidural anesthesia is associated with a lower incidence of cardiopulmonary complications and provides excellent postoperative pain control 75,[103][104][105] Despite studies showing decreased pain scores and opioid consumption in the acute postoperative period, no reduction in chronic pain incidence or severity has been shown. 106,107 Intrathecal Opioids Intrathecal opioids are often used in fast-track cardiac anesthesia to improve acute postoperative pain scores.…”

Assessing advances in regional anesthesia by their portrayals in meta-analyses: an alternative view on recent progress

“…Here we present four topics with more than one meta-analysis (Table 2 ). One of them – “the effect of perioperative epidural analgesia combined with general anesthesia on mortality in cardiac surgery” – did not pass the proof-of-concept test: P -value was >0.05 in any of the 3 included meta-analyses [ 23 – 25 ]. Another topic – “perineural dexamethasone as an analgesic adjunct for peripheral nerve block” – has a definite possibility that this effect is mostly due to the systemic analgesic action of dexamethasone [ 28 , 29 ] described long ago.…”

Impact of high spinal anesthesia technique on fast-track strategy in cardiac surgery: retrospective study

“…TEA has been used throughout the perioperative period by administrating local anesthetic via epidural catheter. A number of studies have shown that the use of TEA in cardiac surgery attenuates the stress response, improves hemodynamic stability and shortens the postoperative ventilation/recovery time 8–17. However, the concern for epidural hematoma formation in the setting of high-dose intraoperative heparin administration has remained 18–20…”