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

Leslie K 1 , McIlroy D 2 , Kasza J 3 , Forbes A 3 , Kurz A 4 , Khan J 5 Show all authors , Meyhoff CS 6 , Allard R 7 , Landoni G 8 , Jara X 9 , Lurati Buse G 10 , Candiotti K 11 , Lee HS 12 , Gupta R 13 , VanHelder T 14 , Purayil W 15 , De Hert S 16 , Treschan T 17 , Devereaux PJ 18

Affiliations 

  • 1 Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia Anaesthesia, Perioperative and Pain Medicine Unit Department of Pharmacology, University of Melbourne, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia kate.leslie@mh.org.au
  • 2 Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
  • 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  • 4 Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
  • 5 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Anesthesiology, University of Toronto, Toronto, Canada
  • 6 Department of Anaesthesiology, Herlev Hospital and University of Copenhagen, Herlev, Denmark
  • 7 Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, Canada
  • 8 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
  • 9 Department of Anesthesiology, Clinica Santa Maria and Universidad de Los Andes, Santiago, Chile
  • 10 Department of Anaesthesiology, Juravinski Hospital, Hamilton, Canada
  • 11 Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miami, USA
  • 12 Department of Anesthesiology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
  • 13 Department of Medicine, Fortis Escorts Hospital, Jaipur, India
  • 14 Department of Anesthesia, Hamilton General Hospital, Hamilton, Canada
  • 15 Department of Anaesthesia, Westfort Hi-tech Hospital, Thrissur, India
  • 16 Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium
  • 17 Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
  • 18 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Departments of Clinical Epidemiology Biostatistics, McMaster University, Hamilton, Canada Department of Medicine, McMaster University, Hamilton, Canada
Br J Anaesth, 2016 Jan;116(1):100-12.
PMID: 26209855 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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