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Epidural analgesia for cardiac surgery

  1. Vesna Svircevic1,*,
  2. Martijn M Passier1,
  3. Arno P Nierich2,
  4. Diederik van Dijk3,
  5. Cor J Kalkman1,
  6. Geert J van der Heijden4

Editorial Group: Cochrane Anaesthesia, Critical and Emergency Care Group

Published Online: 6 JUN 2013

Assessed as up-to-date: 1 NOV 2012

DOI: 10.1002/14651858.CD006715.pub2


How to Cite

Svircevic V, Passier MM, Nierich AP, van Dijk D, Kalkman CJ, van der Heijden GJ. Epidural analgesia for cardiac surgery. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006715. DOI: 10.1002/14651858.CD006715.pub2.

Author Information

  1. 1

    University Medical Center Utrecht, Department of Perioperative Care and Emergency Medicine, Utrecht, Netherlands

  2. 2

    Isala Clinics, Thoracic Anaesthesiology and Intensive care, Zwolle, Netherlands

  3. 3

    University Medical Center Utrecht, Division of Anesthesiology, Intensive Care and Emergency Medicine, Utrecht, Netherlands

  4. 4

    Academic Center for Dentistry Amsterdam (ACTA), Department of Social Dentistry, Amsterdam, Netherlands

*Vesna Svircevic, Department of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, PO Box 85500, Mailstop E 03.511, Utrecht, 3508 GA, Netherlands. vesnasvircevic@hotmail.com. v.svircvic@umcutrecht.nl.

Publication History

  1. Publication Status: New
  2. Published Online: 6 JUN 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Bach 2002 {published data only}
Bakhtiary 2007 {published data only}
  • Bakhtiary F, Therapidis P, Dzemali O, Ak K, Ackermann H, Meininger D, et al. Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: a prospective randomized study. Journal of Thoracic and Cardiovascular Surgery 2007;134:460-4. [MEDLINE: 17662790]
Barrington 2005 {published data only}
  • Barrington MJ, Kluger R, Watson R, Scott DA, Harris KJ. Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage. Anesthesia and Analgesia 2005;100:921-8. [MEDLINE: 15781499]
Berendes 2003 {published data only}
  • Berendes E, Schmidt C, Van Aken H, Hartlage MG, Wirtz S, Reinecke H, et al. Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial. Archives of Surgery 2003;138:1283-90. [MEDLINE: 14662525]
Brix-Christensen 1998 {published data only}
  • Brix-Christensen V, Tonnesen E, Sorensen IJ, Bilfinger TV, Sanchez RG, Stefano GB. Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute-phase protein responses in patients undergoing cardiac surgery. Acta Anaesthesiologica Scandinavica 1998;42:63–70. [MEDLINE: 9527747]
Caputo 2009 {published data only}
  • Caputo M, Alwair H, Rogers CA, Ginty M, Monk C, Tomkins S, et al. Myocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia. The Annals of Thoracic Surgery 2009;87:1119-26. [MEDLINE: 19324137]
Caputo 2011 {published data only}
  • Caputo M, Alwair H, Rogers CA, Pike K, Cohen A, Monk C, et al. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: a prospective, randomized, controlled trial. Anesthesiology 2011;114(2):380-90.
de Vries 2002 {published data only}
  • de Vries AJ, Mariani MA, van der Maaten JM, Loef BG, Lip H. To ventilate or not after minimally invasive direct coronary artery bypass surgery: the role of epidural anesthesia. Journal of Cardiothoracic and Vascular Anesthesia 2002;16:21-6. [MEDLINE: 11854873]
El-Baz 1987 {published data only}
  • El-Baz N, Goldin M. Continuous epidural infusion of morphine for pain relief after cardiac operations. Journal of Cardiovascular Surgery 1987;93:878–83. [MEDLINE: 2952842]
Fillinger 2002 {published data only}
  • Fillinger MP, Yeager MP, Dodds TM, Fillinger MF, Whalen PK, Glass DD. Epidural anesthesia and analgesia: effects on recovery from cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2002;16:15-20. [MEDLINE: 11854872]
Hansdottir 2006 {published data only}
  • Hansdottir V, Philip J, Olsen MF, Eduard C, Houltz E, Ricksten SE. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology 2006;104:142-51. [MEDLINE: 16394700]
Heijmans 2007 {published data only}
  • Heijmans J, Fransen E, Buurman W, Maessen J, Roekaerts P. Comparison of the modulatory effects of four different fast-track anesthetic techniques on the inflammatory response to cardiac surgery with cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia 2007;21:512-8. [MEDLINE: 17678776]
Kendall 2004 {published data only}
Kilickan 2006 {published data only}
  • Kiliçkan L, Gonca S, Dalçik C, Dalçik H, Solak M, Bayindir O, et al. General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2. Journal of cardiovascular surgery 2006;47:315-22. [MEDLINE: 16760868]
Kirno 1994 {published data only}
  • Kirnö K, Friberg P, Grzegorczyk A, Milocco I, Ricksten SE, Lundin S. Thoracic epidural anesthesia during coronary artery bypass surgery: effects on cardiac sympathetic activity, myocardial blood flow and metabolism, and central hemodynamics. Anesthesia and Analgesia 1994;79:1075-81. [MEDLINE: 7978429]
Lagunilla 2006 {published data only}
Liem 1992 {published data only}
  • Liem TH, Hasenbos MA, Booij LH, Gielen MJ. Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome. Journal of Cardiothoracic and Vascular Anesthesia 1992;6:152-6. [MEDLINE: 1533166]
Loick 1999 {published data only}
  • Loick HM, Schmidt C, Van Aken H, Junker R, Erren M, Berendes E, et al. High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesthesia and Analgesia 1999;88:701-9. [MEDLINE: 10195508]
Lundstrom 2005 {published data only}
  • Lundstrom LH, Nygard E, Hviid LB, Pedersen FM, Ravn J, Aldershvile J, et al. The effects of thoracic epidural analgesia on the occurence of late postoperative hypoxemia in patients undergoing elective coronary bypass surgery: a randomized controlled trial. Chest 2005;128:1564-70. [MEDLINE: 16162759]
Moore 1995 {published data only}
Nygard 2004 {published data only}
  • Nygård E, Sørensen LH, Hviid LB, Pedersen FM, Ravn J, Thomassen L, et al. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting. Journal of Cardiothoracic Vascular Anesthesia 2004;18:709-14. [MEDLINE: 15650978]
Onan 2011 {published data only}
  • Onan IS, Onan B, Korkmaz AA, Oklu L, Kilickan L, Gonca S, Dalcik H, Sanisoglu I. Effects of thoracic epidural anesthesia on flow and endothelium of internal thoracic artery in coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia 2011;25(6):1063-70.
Priestley 2002 {published data only}
  • Priestley MC, Cope L, Halliwell R, Gibson P, Chard RB, Skinner M, et al. Thoracic epidural anesthesia for cardiac surgery: The effects on tracheal intubation time and length of hospital stay. Anesthesia and Analgesia 2002;94:275–82. [MEDLINE: 11812684]
Rein 1989 {published data only}
Royse 2003 {published data only}
Scott 2001 {published data only}
  • Scott NB, Turfrey DJ, Ray DAA, Nzewi O, Sutcliffe NP, Lal AB, et al. A Prospective Randomized Study of the Potential Benefits of Thoracic Epidural Anesthesia and Analgesia in Patients Undergoing Coronary Artery Bypass Grafting. Anesthesia and Analgesia 2001;93:528-35. [MEDLINE: 11524314]
Sharma 2010 {published data only}
  • Sharma M, Mehta Y, Sawhney R, Vats M, Trehan N. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery. Annals Cardiac Anaesthesia 2010;13(1):28-33.
Stenseth 1994 {published data only}
Stenseth 1996 {published data only}
  • Stenseth R, Bjella L, Berg EM, Christensen O, Levang OW, Gisvold SE. Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery. European Journal of Cardiothoracic Surgery 1996;10:859-65. [MEDLINE: 8911839]
Svircevic 2011 {published data only}
  • Svircevic V, Nierich AP, Moons KG, Diephuis JC, Ennema JJ, Brandon Bravo Bruinsma GJ, Kalkman CJ, van Dijk D. Thoracic epidural anesthesia for cardiac surgery: a randomized trial. Anesthesiology 2011;114(2):262-70.
Tenling 1999 {published data only}
  • Tenling A, Joachimsson PO, Tydén H, Wegenius G, Hedenstierna G. Thoracic epidural anesthesia as an adjunct to general anesthesia for cardiac surgery: effects on ventilation-perfusion relationships. Journal of Cardiothoracic and Vascular Anesthesia 1999;13:258-64. [MEDLINE: 10392674]

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Chae 1998 {published data only}
Dohle 2001 {published data only}
  • Dhole S, Mehta Y, Saxena H, Juneja R, Trehan N. Comparison of continousthoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia 2001;15:288-292. [MEDLINE: 11426357]
Fawcett 1997 {published data only}
Greisen 2012 {published data only}
Jakobsen 2012 {published data only}
  • Jakobsen CJ, Bhavsar R, Nielsen DV, Ryhammer PK, Sloth E, Greisen J. High thoracic epidural analgesia in cardiac surgery: part 1-high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients. Journal of Cardiothoracic and Vascular Anesthesia 2012;26(6):1039-47.
Jideus 2001 {published data only}
  • Jideus L, Joachimsson PE, Stridsberg M, et al. Thoracic epidural anesthesia does not influence the occurrence of postoperative sustainedatrial fibrillation. Annuals of Thoracic Surgery 2001;72:65-71. [MEDLINE: 11465233]
Kessler 2005 {published data only}
  • Kessler P, Aybek T, Neidhart G, et al. Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: General anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone. Journal of Cardiothoracic and Vascular Anesthesia 2005;19:32-9. [MEDLINE: 15747266]
Liang 2012 {published data only}
  • Liang Y, Chu H, Zhen H, Wang S, Gu M. A prospective randomized study of intraoperative thoracic epidural analgesia in off-pump coronary artery bypass surgery. Journal of Anesthesia 2012;26(3):393-9.
Liem 1992a {published data only}
  • Liem TH, Booij LH, Hasenbos MA, Gielen MJ. Coronary artery bypass grafting using two different anesthetic techniques: Part I: Hemodynamic results. Journal of Cardiothoraocic and Vascular Anesthesia 1992;6:148-55. [MEDLINE: 1533165]
Liem 1992b {published data only}
  • Liem TH, Booij LH, Gielen MJ, Hasenbos MA, van Egmond J. Coronary artery bypass grafting using two different anesthetic techniques: Part 3: Adrenergic responses. Journal of Cardiothoracic and Vascular Anesthesia 1992;6:162-7. [MEDLINE: 1533167]
Mehta 1998 {published data only}
  • Mehta Y, Swaminathan M, Mishra Y, Trehan N. A comparative evaluation of intrapleural pain relief after minimally invasive direct coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia 1998;12:162-5. [MEDLINE: 9583546]
Olivier 2005 {published data only}
Stenseth 1995 {published data only}
  • Stenseth R, Berg EM, Bjella L, Christensen O, Levang OW, Gisvold SE. Effects of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia 1995;9:503-9. [MEDLINE: 8547549]
Thorelius 1996 {published data only}
  • Thorelius J, Ekroth R, Hallhagen S, et al. Thoracolumbar epidural blockade as adjunct to high dose fentanyl/midazolam anesthesia in coronary surgery: Effects of sternotomy. European Journal of Cardiothoracic Surgery 1996;10:754-62.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Ballentyne 1998
  • Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesthesia and Analgesia 1998;86:598-612. [MEDLINE: 9495424]
Bang 2011
  • Bang J, Kim JU, Lee YM, Joh J, An EH, Lee JY, et al. Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient - A case report. Korean Journal of Anesthesiology 2011;61(6):524-7.
Beattie 2003
  • Beattie WS, Badner NH, Choi PT. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesthesia and Analgesia 2003;97:919-20. [MEDLINE: 12933434]
Bowler 2002
  • Bowler I, Djaiani G, Abel R, Pugh S, Dunne J, Hall J. A combination of intrathecal morphine and remifentanil anesthesia for fast-track cardiac anesthesia and surgery. Journal of Cardiothoracic and Vascular Anesthesia 2002;16:709-14. [MEDLINE: 12486651]
Burgess 2006
  • Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. European Heart Journal 2006;27:2846-57. [MEDLINE: 17015402]
Chaney 1997
Chaney 2006
Coriat 2001
Djaiani 2000
  • Djaiani G. Thoracic epidural anesthesia as an adjunct to general anesthesia for cardiac surgery: effects on ventilation-perfusion relationships. Journal of Cardiothoracic and Vascular Anesthesia 2000;14:359-60. [MEDLINE: 10890498]
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration 2011; Vol. www.cochrane-handbook.org.
Ho 2000
Ho 2006
Kerstein 2004
  • Kerstein J, Soodan A, Qamar M, Majid M, Lichstein E, Hollander G, et al. Giving IV and oral amiodarone perioperatively for the prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery: the GAP study. Chest 2004;126:716-24. [MEDLINE: 15364747]
Liu 2004
Meissner 1997
Nicholson 2002
  • Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. Journal of Cardiothoracic and Vascular Anesthesia 2002;16:27-31. [MEDLINE: 11854874]
Oxelbark 2001
RevMan 5.1 [Computer program]
  • The Nordic Cochrane Centre. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, 2011.
Rodgers 2000
  • Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493. [MEDLINE: 11118174]
Rosen 2004
Silbert 1998
Turfrey 1997
Zarate 2000
  • Zarate E, Latham P, White PF, Bossard R, Morse L, Douning LK, et al. Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia. Anesthesia and Analgesia 2000;91:283-7. [MEDLINE: 10910832]