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2. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†

Author

Kate Leslie, W Purayil, T VanHelder, Tanja A. Treschan, Keith A. Candiotti, James S. Khan, Giovanni Landoni, David R. McIlroy, X Jara, Philip J. Devereaux, H. S. Lee, Jessica Kasza, Rajnish K. Gupta, Andrew Forbes, Andrea Kurz, S. De Hert, Christian S. Meyhoff, R. Allard, G. Lurati Buse, Leslie, K, Mcilroy, D, Kasza, J, Forbes, A, Kurz, A, Khan, J, Meyhoff, C, Allard, R, Landoni, Giovanni, Jara, X, Lurati Buse, G, Candiotti, K, Lee, H, Gupta, R, Vanhelder, T, Purayil, W, De Hert, S, Treschan, T, Devereaux, Pj, and Anesthesiology

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Regional Anaesthesia, Myocardial Infarction, Neuraxial blockade, Placebo, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, Anesthesiology, Medicine, Humans, Single-Blind Method, 030212 general & internal medicine, Myocardial infarction, Postoperative Period, Stroke, Aged, Aged, 80 and over, Aspirin, business.industry, Nerve Block, Odds ratio, Middle Aged, medicine.disease, Surgery, Analgesia, Epidural, Anesthesiology and Pain Medicine, Anesthesia, Nerve block, Female, Hypotension, business, medicine.drug
Abstract

Background We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. Methods 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores. Results Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73–1.08; P +0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53–1.35; P +0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74–1.12; P +0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44–2.49; P +0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81–1.00; P +0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89–2.48; P +0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35–1.99; P +0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90–2.61; P +0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18–2.32; P +0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95–2.09; P +0.09). Conclusions Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.

Published
2015

3. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†.

Author

Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, Meyhoff CS, Allard R, Landoni G, Jara X, Lurati Buse G, Candiotti K, Lee HS, Gupta R, VanHelder T, Purayil W, De Hert S, Treschan T, and Devereaux PJ

Subjects
Aged, Aged, 80 and over, Female, Humans, Hypotension epidemiology, Male, Middle Aged, Myocardial Infarction epidemiology, Postoperative Period, Single-Blind Method, Stroke epidemiology, Analgesia, Epidural statistics & numerical data, Nerve Block statistics & numerical data, Postoperative Complications epidemiology
Abstract

Background: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects., Methods: 10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxial block was defined as intraoperative spinal anaesthesia, or thoracic or lumbar epidural anaesthesia. Postoperative epidural analgesia was defined as postoperative epidural local anaesthetic and/or opioid administration. We used logistic regression with weighting using estimated propensity scores., Results: Neuraxial block was not associated with the primary outcome [7.5% vs 6.5%; odds ratio (OR), 0.89; 95% CI (confidence interval), 0.73-1.08; P=0.24], death (1.0% vs 1.4%; OR, 0.84; 95% CI, 0.53-1.35; P=0.48), myocardial infarction (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63% vs 36%; OR, 1.40; 95% CI, 0.95-2.09; P=0.09)., Conclusions: Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects., (© The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Published
2016
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