Summary of findings 2. Epidural analgesia compared with peripheral nerve blocks for cardiac surgery in adult.
| Epidural analgesia compared with peripheral nerve blocks for cardiac surgery without cardiopulmonary bypass in adults | ||||||
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Patient or population: adults undergoing cardiac surgery without cardiopulmonary bypass Settings: trials were conducted in university hospitals in Egypt (n = 1) or India (n = 3) Intervention: epidural analgesia Comparison: peripheral nerve blocks (erector spinae plane block (n = 1) or paravertebral blockade (n = 3)) | ||||||
| Outcomes | Illustrative comparative risks (95% CI)* | Risk difference or relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Peripheral nerve block | Epidural analgesia | |||||
| Mortallity (0 to 30 days | Study population | RD ‐0.03 (‐0.08 to 0.02) |
145 (1 study) |
⊕⊝⊝⊝ very lowa |
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| 43 per 1000 |
13 per 1000 (2 to 72) |
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|
Myocardial infarction (0 to 30 days) |
Study population | RD 0.00 (‐0.07 to 0.07) |
76 (2 studies) |
⊕⊝⊝⊝ very lowa |
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| 0 per 1000 |
0 per 1000 (0 to 90) |
|||||
|
Pulmonary complications (0 to 30 days) |
We found no data for this outcome (respiratory depression or pneumonia) | |||||
|
Atrial fibrillation or atrial flutter (0 to 2 weeks) |
We found no data for this outcome | |||||
|
Risk of neurological complications (0 to 30 days) |
Cerebrovascular accident | |||||
| Study population |
RD 0.00 (‐0.03 to 0.03) |
145 (1 study) |
⊕⊝⊝⊝ very lowa |
|||
| 0 per 1000 |
0 per 1000 (0 to 49) |
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| Epidural haematoma | ||||||
| Study population |
RD 0.00 (‐0.03 to 0.03) |
271 (4 studies) |
⊕⊕⊝⊝ lowb |
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| 0 per 1000 |
0 per 1000 (0 to 27) |
|||||
| Duration of tracheal intubation | Study population |
MD ‐0.08 hour (‐0.54 to 0.38 hour) |
271 (4 studies) |
⊕⊝⊝⊝ very lowa |
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| 6.82 ± 2.14 hours (mean ± SD) | 6.67 ± 2.31 hours (mean ± SD) | |||||
|
Pain at rest at 6 to 8
hours after surgery (score from 0 to 10) |
Study population |
MD 0.12 (‐0.42 to 0.66) |
90 (2 studies) |
⊕⊝⊝⊝ very lowa |
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| 2.20 ± 0.79 (mean ± SD) |
1.80 ± 0.22 (mean ± SD) |
|||||
|
Haemodynamic support (in hospital) |
Hypotension or need for vasopressor boluses |
RD 0.05 (‐0.08 to 0.18) |
40 (1 study) |
⊕⊕⊝⊝ lowb |
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| Study population | ||||||
| 50 per 1000 | 0 per 1000 (0 to 161) |
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| Inotropic or vasopressor infusions | ||||||
| We found no data for this outcome | ||||||
| *The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Confidence intervals were calculated using VassarStats (http://www.vassarstats.net/) with no continuity correction. CI: confidence interval; MD: mean difference; RD: risk difference; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence. High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aDowngraded by one for risk of bias and by two levels for imprecision.
bDowngraded by two levels for imprecision.