Epidural analgesia reduces postoperative myocardial infarction: A meta-analysis

Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. Postoperative epidural analgesia is considered to have beneficial effects on cardiac outcomes. The use in highrisk cardia c patients remains controversial. No study has shown that postoperative epi dural analgesia decreases Postoperative myocardial infarction (PMI) or deat h. All studies are underpowered to show such a result, and the cost of cond ucting a large trial is prohibitive. We performed a metaanalysis to determi ne whether postoperative epidural analgesia continued for more than 24 h af ter surgery reduces PMI or in-hospital death. The available databases were searched for randomized controlled trials of epidural analgesia that was ex tended at least 24 h into the postoperative period. The search yielded 17 s tudies, of which 11 were randomized controlled trials comprising 1173 patie nts. Metaanalysis was conducted by using the fixed-effects model, calculati ng both an odds ratio and a rate difference. Postoperative epidural analges ia resulted in better analgesia for the first 24 h after surgery. The rate of PMI was 6.3%, with lower rates in the Epidural group (rate difference, - 3.8%; 95% confidence interval [CI] -7.4%, -0.2%; P = 0.049). The frequency of in-hospital death was 3.3%, with no significant difference between Epidu ral and Nonepidural groups (rate difference, -1.3%; 95% CL -3.8%, 1.2%, P = 0.091). Subgroup analysis of postoperative thoracic epidural analgesia sho wed a significant reduction in PMI in the Epidural group (rate difference, -5.3%; 95% CI, -9.9%, -0.7%; P = 0.04).