Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: A meta-analysis

Spencer S. Liu, Brian M. Block, Christopher L. Wu

Research output: Contribution to journalArticle

Abstract

Background: Perioperative central neuraxial analgesia may improve outcome after coronary artery bypass surgery due to attenuation of stress response and superior analgesia. Methods: MEDLINE and other databases were searched for randomized controlled trials in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass who were randomized to either general anesthesia (GA) versus general anesthesia-thoracic epidural analgesia (TEA) or general anesthesia-intrathecal analgesia (IT). Results: Fifteen trials enrolling 1,178 patients were included for TEA analysis. TEA did not affect incidences of mortality (0.7% TEA vs. 0.3% GA) or myocardial infarction (2.3% TEA vs. 3.4% GA). TEA significantly reduced the risk of dysrhythmias with an odds ratio of 0.52, pulmonary complications with an odds ratio of 0.41, and time to tracheal extubation by 4.5 h and reduced analog pain scores at rest by 7.8 mm and with activity by 11.6 mm. Seventeen trials enrolling 668 patients were included for IT analysis. IT had no significant effect on incidences of mortality (0.3% IT vs. 0.6% GA), myocardial infarction (3.9% IT vs. 5.7% GA), dysrhythmias (24.8% vs. 29.1%), nausea/vomiting (31.3% vs. 28.5%), or time to tracheal extubation (10.4 h IT vs. 10.9 h GA). IT modestly decreased systemic morphine use by 11 mg and decreased pain scores by 16 mm. IT significantly increased the incidence of pruritus (10% vs. 2.5%). Conclusions: There were no differences in the rates of mortality or myocardial infarction after coronary artery bypass grafting with central neuraxial analgesia. There were associated improvements in faster time until tracheal extubation, decreased pulmonary complications and cardiac dysrhythmias, and reduced pain scores.

Original languageEnglish (US)
Pages (from-to)153-161
Number of pages9
JournalAnesthesiology
Volume101
Issue number1
DOIs
StatePublished - Jul 2004

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Coronary Artery Bypass
Analgesia
Meta-Analysis
General Anesthesia
Epidural Analgesia
Thorax
Airway Extubation
Myocardial Infarction
Pain
Mortality
Incidence
Odds Ratio
Anesthesia and Analgesia
Lung
Epidural Anesthesia
Pruritus
Cardiopulmonary Bypass
MEDLINE
Morphine
Nausea

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery : A meta-analysis. / Liu, Spencer S.; Block, Brian M.; Wu, Christopher L.

In: Anesthesiology, Vol. 101, No. 1, 07.2004, p. 153-161.

Research output: Contribution to journalArticle

Liu, Spencer S. ; Block, Brian M. ; Wu, Christopher L. / Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery : A meta-analysis. In: Anesthesiology. 2004 ; Vol. 101, No. 1. pp. 153-161.
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