Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Jan;116(1):100-12.
doi: 10.1093/bja/aev255. Epub 2015 Jul 25.

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

K Leslie  1 , D McIlroy  2 , J Kasza  3 , A Forbes  3 , A Kurz  4 , J Khan  5 , C S Meyhoff  6 , R Allard  7 , G Landoni  8 , X Jara  9 , G Lurati Buse  10 , K Candiotti  11 , H-S Lee  12 , R Gupta  13 , T VanHelder  14 , W Purayil  15 , S De Hert  16 , T Treschan  17 , P J Devereaux  18
Affiliations
Randomized Controlled Trial

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

K Leslie et al. Br J Anaesth. 2016 Jan.

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.

Keywords: anaesthesia, epidural; anaesthesia, spinal; death; myocardial infarction; stroke.

PubMed Disclaimer

References

    1. Landoni G, Rodseth R, Santini F, et al. Randomized evidence for reduction of perioperative mortality. J Thorac Cardiovasc Anesth 2012; 26: 764–72 - PubMed
    1. Kooij F, Schlack W, Preckel B, Hollmann M. Does regional analgesia for major surgery improve outcome? Focus on epidural analgesia. Anesth Analg 2014; 119: 740–4 - PubMed
    1. Memtsoudis S, Liu S. Do neuraxial techniques affect perioperative outcomes? The story of vantage points and number games. Anesth Analg 2014; 119: 501–2 - PubMed
    1. Popping D, Van Aken H, Brodner G, Wenk M. It is not the epidural that is dangerous, but the person who gives it. Br J Anaesth 2014; 112: 392–3 - PubMed
    1. Park W, Thompson J, Lee K. Effect of epidural anesthesia and analgesia on perioperative outcomes. Ann Surg 2001; 234: 560–71 - PMC - PubMed

Publication types