Epidural analgesia during surgery and its relation to postoperative myocardial infarction: meta-analysis

Introduction
Epidural analgesia has been studied for its potential advantages after surgery in a number of randomized clinical trials, with most finding improvements in pain and secondary endpoints like the incidence of postoperative complications.

Aim
To assess the relationship between use of epidural analgesia and adverse cardiac outcomes expressed by myocardial infarction (MI).

Material and methods
Fifty-three studies were recruited to quantify the influence of different surgical-related analgesic methods on clinical parameters (mortality and adverse events). The results of these trials were analysed using a random effects model, which was then used to calculate the mean difference (MD) with 95 per cent confidence intervals (CIs).

Results
Epidural analgesia resulted in preferred cardiac outcomes compared with traditional analgesia. These findings were supported by significantly lower MI events for the epidural analgesia group as follows: p = 0.005, p = 0,007, and p = 0.03 for the total number of included studies, studies with high risk of bias, and studies with low risk of bias, respectively. Studies with intermediate risk showed a non-significant difference between both groups (p = 0.7).

Conclusions
Epidural analgesia has a significant protective cardiac effect through the reduction of postoperative MI events among surgery subjects.