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

K Leslie; D McIlroy; J Kasza; A Forbes; A Kurz; J Khan; C S Meyhoff; R Allard; G Landoni; X Jara; G Lurati Buse; K Candiotti; H-S Lee; R Gupta; T VanHelder; W Purayil; S De Hert; T Treschan; P J Devereaux

doi:10.1093/bja/aev255

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

K Leslie, D McIlroy, J Kasza, A Forbes, A Kurz, J Khan, C S Meyhoff, R Allard, G Landoni, X Jara, G Lurati Buse, K Candiotti, H-S Lee, R Gupta, T VanHelder, W Purayil, S De Hert, T Treschan, P J Devereaux

Bedøvelse, Operation og Intensiv Behandling Herlev

22 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	British Journal of Anaesthesia
Vol/bind	116
Udgave nummer	1
Sider (fra-til)	100-12
Antal sider	13
ISSN	0007-0912
DOI	https://doi.org/10.1093/bja/aev255
Status	Udgivet - jan. 2016

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10.1093/bja/aev255

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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. (2016). Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†. British Journal of Anaesthesia, 116(1), 100-12. https://doi.org/10.1093/bja/aev255

Leslie, K, McIlroy, D, Kasza, J, Forbes, A, Kurz, A, Khan, J, Meyhoff, CS, 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, PJ 2016, 'Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial†', British Journal of Anaesthesia, bind 116, nr. 1, s. 100-12. https://doi.org/10.1093/bja/aev255

@article{f3690abd09cb49958ae5c9b254fe1889,

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

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 = "Aged, Aged, 80 and over, Analgesia, Epidural, Female, Humans, Hypotension, Male, Middle Aged, Myocardial Infarction, Nerve Block, Postoperative Complications, Postoperative Period, Single-Blind Method, Stroke, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "K Leslie and D McIlroy and J Kasza and A Forbes and A Kurz and J Khan and Meyhoff, {C S} and R Allard and G Landoni and X Jara and {Lurati Buse}, G and K Candiotti and H-S Lee and R Gupta and T VanHelder and W Purayil and {De Hert}, S and T Treschan and Devereaux, {P J}",

year = "2016",

month = jan,

doi = "10.1093/bja/aev255",

language = "English",

volume = "116",

pages = "100--12",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier Limited",

number = "1",

}

TY - JOUR

T1 - Neuraxial block and postoperative epidural analgesia

T2 - effects on outcomes in the POISE-2 trial†

AU - Leslie, K

AU - McIlroy, D

AU - Kasza, J

AU - Forbes, A

AU - Kurz, A

AU - Khan, J

AU - Meyhoff, C S

AU - Allard, R

AU - Landoni, G

AU - Jara, X

AU - Lurati Buse, G

AU - Candiotti, K

AU - Lee, H-S

AU - Gupta, R

AU - VanHelder, T

AU - Purayil, W

AU - De Hert, S

AU - Treschan, T

AU - Devereaux, P J

PY - 2016/1

Y1 - 2016/1

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Analgesia, Epidural

KW - Female

KW - Humans

KW - Hypotension

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Nerve Block

KW - Postoperative Complications

KW - Postoperative Period

KW - Single-Blind Method

KW - Stroke

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1093/bja/aev255

DO - 10.1093/bja/aev255

M3 - Journal article

C2 - 26209855

SN - 0007-0912

VL - 116

SP - 100

EP - 112

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

ER -

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

Abstract

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