Impact of Epidural Analgesia on Mortality and Morbidity After Surgery Systematic Review and Meta-analysis of Randomized Controlled Trials

被引:343
作者
Poepping, Daniel M. [1 ]
Elia, Nadia [2 ]
Van Aken, Hugo K. [1 ]
Marret, Emmanuel [3 ]
Schug, Stephan A. [4 ]
Kranke, Peter [5 ]
Wenk, Manuel [1 ]
Tramer, Martin R. [6 ,7 ]
机构
[1] Univ Hosp Munster, Dept Anesthesiol Intens Care & Pain Med, Munster, Germany
[2] Univ Geneva, Fac Med, Inst Social & Prevent Med, CH-1211 Geneva 4, Switzerland
[3] Tenon Univ Hosp, Assistance Publ Hop Paris, Dept Anesthesia & Intens Care, Paris, France
[4] Univ Western Australia, Anesthesiol Unit, Sch Med & Pharmacol, Nedlands, WA 6009, Australia
[5] Univ Hosp Wurzburg, Dept Anesthesia & Crit Care, Wurzburg, Germany
[6] Univ Geneva, Univ Hosp Geneva, Div Anesthesiol, CH-1211 Geneva 4, Switzerland
[7] Univ Geneva, Fac Med, CH-1211 Geneva 4, Switzerland
关键词
epidural analgesia; mortality; morbidity; perioperative; PATIENT-CONTROLLED ANALGESIA; ARTERY-BYPASS-SURGERY; POSTOPERATIVE PULMONARY COMPLICATIONS; CONTROLLED INTRAVENOUS ANALGESIA; MAJOR ABDOMINAL OPERATIONS; GENERAL-ANESTHESIA; CARDIAC-SURGERY; ATRIAL-FIBRILLATION; LOCAL-ANESTHETICS; CLINICAL-TRIAL;
D O I
10.1097/SLA.0000000000000237
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To quantify benefit and harm of epidural analgesia, compared with systemic opioid analgesia, in adults having surgery under general anesthesia. Background: It remains controversial whether adding epidural analgesia to general anesthesia decreases postoperative morbidity and mortality. Methods: We searched CENTRAL, EMBASE, PubMed, CINAHL, and BIOSIS till July 2012. We included randomized controlled trials comparing epidural analgesia (with local anesthetics, lasting for >= 24 hours postoperatively) with systemic analgesia in adults having surgery under general anesthesia, and reporting on mortality or any morbidity endpoint. Results: A total of 125 trials (9044 patients, 4525 received epidural analgesia) were eligible. In 10 trials (2201 patients; 87 deaths), reporting on mortality as a primary or secondary endpoint, the risk of death was decreased with epidural analgesia (3.1% vs 4.9%; odds ratio, 0.60; 95% confidence interval, 0.39-0.93). Epidural analgesia significantly decreased the risk of atrial fibrillation, supraventricular tachycardia, deep vein thrombosis, respiratory depression, atelectasis, pneumonia, ileus, and postoperative nausea and vomiting, and also improved recovery of bowel function, but significantly increased the risk of arterial hypotension, pruritus, urinary retention, and motor blockade. Technical failures occurred in 6.1% of patients. Conclusions: In adults having surgery under general anesthesia, concomitant epidural analgesia reduces postoperative mortality and improves a multitude of cardiovascular, respiratory, and gastrointestinal morbidity endpoints compared with patients receiving systemic analgesia. Because adverse effects and technical failures cannot be ruled out, individual risk-benefit analyses and professional care are recommended.
引用
收藏
页码:1056 / 1067
页数:12
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