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

• Published in: British journal of anaesthesia : BJA Vol. 116; no. 1; pp. 100 - 112
• Main Authors: Leslie, K., McIlroy, D., Kasza, J., Forbes, A., Kurz, A., Khan, J., Meyhoff, C. S., Allard, R., Landoni, G., Jara, X., Lurati Buse, G., Candiotti, K., Lee, H-S., Gupta, R., VanHelder, T., Purayil, W., De Hert, S., Treschan, T., Devereaux, P. J.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2016
• Subjects: Aged; Aged, 80 and over; Analgesia, Epidural - statistics & numerical data; Female; Humans; Hypotension - epidemiology; Male; Middle Aged; Myocardial Infarction - epidemiology; Nerve Block - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Period; Regional Anaesthesia; Single-Blind Method; Stroke - epidemiology; anaesthesia, spinal; anaesthesia, epidural; death; stroke; myocardial infarction
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aev255

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.