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

(2016) BRITISH JOURNAL OF ANAESTHESIA. 116(1). p.100-112
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Abstract
Background: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatalmyocardial 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
epidural, anaesthesia, anaesthesia, spinal, death, myocardial infarction, stroke, SERIOUS CARDIOVASCULAR MORBIDITY, RANDOMIZED CONTROLLED-TRIAL, HIP FRACTURE SURGERY, NONCARDIAC SURGERY, PROPENSITY SCORES, MYOCARDIAL-INFARCTION, ANESTHESIA TECHNIQUE, MAJOR SURGERY, METAANALYSIS, MORTALITY

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Chicago
Leslie, K, D McIlroy, J Kasza, A Forbes, A Kurz, J Khan, C Meyhoff, et al. 2016. “Neuraxial Block and Postoperative Epidural Analgesia: Effects on Outcomes in the POISE-2 Trial.” British Journal of Anaesthesia 116 (1): 100–112.
APA
Leslie, K., McIlroy, D., Kasza, J., Forbes, A., Kurz, A., Khan, J., Meyhoff, C., et al. (2016). Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial. BRITISH JOURNAL OF ANAESTHESIA, 116(1), 100–112.
Vancouver
1.
Leslie K, McIlroy D, Kasza J, Forbes A, Kurz A, Khan J, et al. Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial. BRITISH JOURNAL OF ANAESTHESIA. 2016;116(1):100–12.
MLA
Leslie, K et al. “Neuraxial Block and Postoperative Epidural Analgesia: Effects on Outcomes in the POISE-2 Trial.” BRITISH JOURNAL OF ANAESTHESIA 116.1 (2016): 100–112. Print.
@article{7078224,
  abstract     = {Background: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatalmyocardial 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.},
  author       = {Leslie, K and McIlroy, D and Kasza, J and Forbes, A and Kurz, A and Khan, J and Meyhoff, C and Allard, R and Landoni, G and Jara, X and Lurati Buse, G and Candiotti, K and Lee, H-S and Gupta, R and VanHelder, T and Purayil, W and De Hert, Stefan and Treschan, T and Devereaux, PJ},
  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  keywords     = {epidural,anaesthesia,anaesthesia,spinal,death,myocardial infarction,stroke,SERIOUS CARDIOVASCULAR MORBIDITY,RANDOMIZED CONTROLLED-TRIAL,HIP FRACTURE SURGERY,NONCARDIAC SURGERY,PROPENSITY SCORES,MYOCARDIAL-INFARCTION,ANESTHESIA TECHNIQUE,MAJOR SURGERY,METAANALYSIS,MORTALITY},
  language     = {eng},
  number       = {1},
  pages        = {100--112},
  title        = {Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial},
  url          = {http://dx.doi.org/10.1093/bja/aev255},
  volume       = {116},
  year         = {2016},
}

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