Epidural analgesia for cardiac surgery

Abstract

This meta-analysis of studies, identified to 2010, showed that the use of TEA in patients undergoing coronary artery bypass graft surgery may reduce the risk of postoperative supraventricular arrhythmias and respiratory complications. There were no effects of TEA with GA on the risk of mortality, myocardial infarction or neurological complications compared with GA alone.

High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study

“…Furthermore, the rest of major postoperative outcome parameters including neurologic complications, renal impairment, myocardial dysfunction, infective complications and perioperative mortality did not differ between the study groups either, which corresponds to the results of a recent, large meta-analysis (Svircevic et al 2013 ). On the other hand, we also did not notice any reduction in the incidence of supraventricular arrhythmias which has been reported by our previous study with TEA awake patients (Porizka et al 2011 ) and a meta-analysis (Svircevic et al 2013 ). However, when looking at these published data from meta-analysis more closely, we discover that in the large study by Scott et al ( 2001 ) B-blockers were discontinued 5 days preoperatively, which must have contributed significantly to increased incidence of postoperative arrhythmias.…”

“…On the other hand, such ESII scores represent relatively low risk category of cardiac surgical patients. This may be the reason why we did not observe beneficial effects of epidural anesthesia (lower incidence of pulmonary complications and supraventricular arrhythmias) reported by recent meta-analyses (Svircevic et al 2011 , 2013 ) and these effects might become more apparent when higher risk patients, especially those with pulmonary or cardiac dysfunction, are involved.…”

“…Nevertheless, in our study, better analgesia and shorter ventilation times in the TEA group did not result in reduced incidence of these respiratory complications, as they were equally frequent in both study groups (Table 3 ). That is in contrast to the latest meta-analysis that showed a lower risk of respiratory events for patients receiving TEA during surgery compared with those receiving GA alone (Svircevic et al 2013 ). However, in a recent study, it was demonstrated that an early extubation (within 9 h after cardiac surgery) is associated with an improved outcome and was shown to be the best predictor of uncomplicated recovery (Camp et al 2009 ).…”

High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study

“…Furthermore, the rest of major postoperative outcome parameters including neurologic complications, renal impairment, myocardial dysfunction, infective complications and perioperative mortality did not differ between the study groups either, which corresponds to the results of a recent, large meta-analysis (Svircevic et al 2013 ). On the other hand, we also did not notice any reduction in the incidence of supraventricular arrhythmias which has been reported by our previous study with TEA awake patients (Porizka et al 2011 ) and a meta-analysis (Svircevic et al 2013 ). However, when looking at these published data from meta-analysis more closely, we discover that in the large study by Scott et al ( 2001 ) B-blockers were discontinued 5 days preoperatively, which must have contributed significantly to increased incidence of postoperative arrhythmias.…”

“…On the other hand, such ESII scores represent relatively low risk category of cardiac surgical patients. This may be the reason why we did not observe beneficial effects of epidural anesthesia (lower incidence of pulmonary complications and supraventricular arrhythmias) reported by recent meta-analyses (Svircevic et al 2011 , 2013 ) and these effects might become more apparent when higher risk patients, especially those with pulmonary or cardiac dysfunction, are involved.…”

“…Nevertheless, in our study, better analgesia and shorter ventilation times in the TEA group did not result in reduced incidence of these respiratory complications, as they were equally frequent in both study groups (Table 3 ). That is in contrast to the latest meta-analysis that showed a lower risk of respiratory events for patients receiving TEA during surgery compared with those receiving GA alone (Svircevic et al 2013 ). However, in a recent study, it was demonstrated that an early extubation (within 9 h after cardiac surgery) is associated with an improved outcome and was shown to be the best predictor of uncomplicated recovery (Camp et al 2009 ).…”

Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

“…Moreover, epidural analgesia has been associated with a reduction in patient mortality, but the beneficial effect was rather low (number needed to treat (NNT) = 70). Other authors did not observe a higher risk of epidural hematoma in cardiac surgery patients than in general surgery patients [23,24]. The risk of hematoma after PVB in cardiothoracic surgery seems to be even lower [25,26].…”

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

“… 5 Chan et al, 2014 [ 20 ] Femoral nerve block improved analgesia, defined as decrease in pain score at rest at 24 h postoperatively, as compared with systemic opioids (patient-controlled analgesia). 6 Svircevic et al, 2013 [ 24 ] Thoracic epidural anesthesia given in combination with general anesthesia reduced the risk of mortality in patients undergoing cardiac surgery as compared with general anesthesia alone. 7 Ong et al, 2005 [ 26 ] Preincisional administration of epidural analgesics decreased postoperative (24–48 h) pain scores to a greater degree than similar postincisional analgesic interventions.…”

High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study

“…Furthermore, the rest of major postoperative outcome parameters including neurologic complications, renal impairment, myocardial dysfunction, infective complications and perioperative mortality did not differ between the study groups either, which corresponds to the results of a recent, large meta-analysis (Svircevic et al 2013 ). On the other hand, we also did not notice any reduction in the incidence of supraventricular arrhythmias which has been reported by our previous study with TEA awake patients (Porizka et al 2011 ) and a meta-analysis (Svircevic et al 2013 ). However, when looking at these published data from meta-analysis more closely, we discover that in the large study by Scott et al ( 2001 ) B-blockers were discontinued 5 days preoperatively, which must have contributed significantly to increased incidence of postoperative arrhythmias.…”

“…On the other hand, such ESII scores represent relatively low risk category of cardiac surgical patients. This may be the reason why we did not observe beneficial effects of epidural anesthesia (lower incidence of pulmonary complications and supraventricular arrhythmias) reported by recent meta-analyses (Svircevic et al 2011 , 2013 ) and these effects might become more apparent when higher risk patients, especially those with pulmonary or cardiac dysfunction, are involved.…”

“…Nevertheless, in our study, better analgesia and shorter ventilation times in the TEA group did not result in reduced incidence of these respiratory complications, as they were equally frequent in both study groups (Table 3 ). That is in contrast to the latest meta-analysis that showed a lower risk of respiratory events for patients receiving TEA during surgery compared with those receiving GA alone (Svircevic et al 2013 ). However, in a recent study, it was demonstrated that an early extubation (within 9 h after cardiac surgery) is associated with an improved outcome and was shown to be the best predictor of uncomplicated recovery (Camp et al 2009 ).…”

Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

“…Moreover, epidural analgesia has been associated with a reduction in patient mortality, but the beneficial effect was rather low (number needed to treat (NNT) = 70). Other authors did not observe a higher risk of epidural hematoma in cardiac surgery patients than in general surgery patients [23,24]. The risk of hematoma after PVB in cardiothoracic surgery seems to be even lower [25,26].…”

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

“… 5 Chan et al, 2014 [ 20 ] Femoral nerve block improved analgesia, defined as decrease in pain score at rest at 24 h postoperatively, as compared with systemic opioids (patient-controlled analgesia). 6 Svircevic et al, 2013 [ 24 ] Thoracic epidural anesthesia given in combination with general anesthesia reduced the risk of mortality in patients undergoing cardiac surgery as compared with general anesthesia alone. 7 Ong et al, 2005 [ 26 ] Preincisional administration of epidural analgesics decreased postoperative (24–48 h) pain scores to a greater degree than similar postincisional analgesic interventions.…”

High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study

“…Furthermore, the rest of major postoperative outcome parameters including neurologic complications, renal impairment, myocardial dysfunction, infective complications and perioperative mortality did not differ between the study groups either, which corresponds to the results of a recent, large meta-analysis (Svircevic et al 2013 ). On the other hand, we also did not notice any reduction in the incidence of supraventricular arrhythmias which has been reported by our previous study with TEA awake patients (Porizka et al 2011 ) and a meta-analysis (Svircevic et al 2013 ). However, when looking at these published data from meta-analysis more closely, we discover that in the large study by Scott et al ( 2001 ) B-blockers were discontinued 5 days preoperatively, which must have contributed significantly to increased incidence of postoperative arrhythmias.…”

“…On the other hand, such ESII scores represent relatively low risk category of cardiac surgical patients. This may be the reason why we did not observe beneficial effects of epidural anesthesia (lower incidence of pulmonary complications and supraventricular arrhythmias) reported by recent meta-analyses (Svircevic et al 2011 , 2013 ) and these effects might become more apparent when higher risk patients, especially those with pulmonary or cardiac dysfunction, are involved.…”

“…Nevertheless, in our study, better analgesia and shorter ventilation times in the TEA group did not result in reduced incidence of these respiratory complications, as they were equally frequent in both study groups (Table 3 ). That is in contrast to the latest meta-analysis that showed a lower risk of respiratory events for patients receiving TEA during surgery compared with those receiving GA alone (Svircevic et al 2013 ). However, in a recent study, it was demonstrated that an early extubation (within 9 h after cardiac surgery) is associated with an improved outcome and was shown to be the best predictor of uncomplicated recovery (Camp et al 2009 ).…”

Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

“…Moreover, epidural analgesia has been associated with a reduction in patient mortality, but the beneficial effect was rather low (number needed to treat (NNT) = 70). Other authors did not observe a higher risk of epidural hematoma in cardiac surgery patients than in general surgery patients [23,24]. The risk of hematoma after PVB in cardiothoracic surgery seems to be even lower [25,26].…”

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

“… 5 Chan et al, 2014 [ 20 ] Femoral nerve block improved analgesia, defined as decrease in pain score at rest at 24 h postoperatively, as compared with systemic opioids (patient-controlled analgesia). 6 Svircevic et al, 2013 [ 24 ] Thoracic epidural anesthesia given in combination with general anesthesia reduced the risk of mortality in patients undergoing cardiac surgery as compared with general anesthesia alone. 7 Ong et al, 2005 [ 26 ] Preincisional administration of epidural analgesics decreased postoperative (24–48 h) pain scores to a greater degree than similar postincisional analgesic interventions.…”