Cardiothoracic & vascular anesthesia
Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials
Authors' conclusion
TEA reduces ICU and hospital length of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications such as epidural hematomas.
Study context
- Population
- Adults undergoing cardiac surgery51 randomized controlled trials (RCTs)
- Participants
- 2,112 vs 2,220
- Comparison
- Thoracic epidural anesthesia (TEA) vs general anesthesia (GA) only
- TEAn = 2,112
- GAn = 2,220reference
- Outcome
- ICU LOS, hospital LOS, extubation time (ET), and mortality
Methodological detailsrandom-effects, trial sequential analysis, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)
- Random-effects
- Trial sequential analysis
- GRADE
Pooled result
As reported in the abstract
Intensive care unit (ICU) LOS
−6.9 hours
95% CI −12.5 to −1.2P = 0.018
TEA
Hospital LOS
−0.8 days
95% CI −1.1 to −0.4P < 0.0001
TEA
Extubation time
−2.9 hours
95% CI −3.7 to −2.0P < 0.0001
TEA
Further pooled results
Pain scores, pooled pulmonary complications, transfusion requirements, delirium, arrhythmia
- Significantly reduced with TEA
Safety
Epidural hematoma
- No additional complications; estimated risk
- <0.14%
Original publication
Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Anesth Analg. Published 23 May 2023. doi:10.
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