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Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†.
- Source :
-
BJA: The British Journal of Anaesthesia . Jan2016, Vol. 116 Issue 1, p100-112. 13p. - Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects. [ABSTRACT FROM AUTHOR]
- Subjects :
- *EPIDURAL analgesia
*SPINAL anesthesia
*CLINICAL trials
*MYOCARDIAL infarction
*DEATH
*SURGICAL complications
*HEALTH outcome assessment
*COMPARATIVE studies
*HYPOTENSION
*RESEARCH methodology
*MEDICAL cooperation
*NERVE block
*POSTOPERATIVE period
*RESEARCH
*STROKE
*EVALUATION research
*RANDOMIZED controlled trials
*BLIND experiment
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 116
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 111884360
- Full Text :
- https://doi.org/10.1093/bja/aev255