1. Postoperative analgesia.
| Study | Regional blockade | Comparator |
| Aguero‐Martinez 2012 | TEA (T3‐T4) with 10 mL bupivacaine 0.5% and morphine 5 mg administered at least 1 hour before IV heparin | Low doses of opioids |
| Bach 2002 | TEA (T12‐L1) inserted the evening before surgery Bupivacaine 0.25% 10 mL Bupivacaine 0.25% ((body height (cm) − 100) × 10‐1 = mL/h) for 18 hours Catheter removed on the second or third day after surgery when coagulation parameters had returned to normal range |
Not reported |
| Bakhtiary 2007 | TEA (T1‐T3; soft multi‐port) inserted the day before surgery 6 mL ropivacaine 0.16% plus sufentanil 1 mcg/mL Ropivacaine 0.16% plus sufentanil 1 mcg/mL at 2 to 5 mL/h started before surgery and continued for 3 days after surgery |
Metamizole and piritramide |
| Barrington 2005 | TEA (T1‐T3) (20‐gauge; Portex, Hythe, Kent, UK) inserted 4 cm cephalad the day before surgery using a midline approach and a loss of resistance to saline technique Ropivacaine 1% 5 mL and fentanyl 50 mcg (adjusted for T1 to T6 sensory block) Ropivacaine 0.2% and fentanyl 2 mcg/mL 5 mL/h started 1 hour after induction and continued until morning of postoperative day 3 (adjusted on pain scores) |
IV morphine infusion and infiltration of chest drain sites |
| Bektas 2015 | TEA (T2‐T4) inserted 5 cm into the epidural space 1 day before surgery Lidocaine 60 mg Levobupivacaine 0.25% 0.1 mL/kg/min and fentanyl 2 mcg/kg/min bolus for T1‐L2 sensory block Levobupivacaine 0.25% 0.1 mL/kg/h and fentanyl 2 mcg/mL |
IV PCA with morphine for 24 hours |
| Berendes 2003 | TEA (C7‐T1) with a median approach and a hanging drop technique inserted the day before surgery 2 mL of 0.5% bupivacaine with epinephrine Bupivacaine 0.5% at 6 to 12 mL/h plus sufentanil 15 to 25 mcg started just before surgery and kept for 4 days |
Not reported |
| Brix‐Christensen 1998 | TEA (T3‐T4) inserted at least 12 hours before surgery Bupivacaine 0.5% 8 mL 30 minutes before induction of anaesthesia Continuous infusion with bupivacaine 2 mg/mL and fentanyl 5 mcg/mL at 5 mL/h during and after surgery until the second postoperative day |
IV morphine |
| Caputo 2011 | TEA (T2‐T4) inserted before surgery Bupivacaine 0.5% 5 + 5 mL Bupivacaine 0.125% plus clonidine 0.0003% 10 mL/hour started after induction and continued for 72 hours (adjusted for T1 to T10 sensory block and on pain scores) |
IV PCA with morphine |
| Celik 2015 | TEA (T5‐T6) inserted the day before surgery Levobupivacaine 2 mcg/mL and fentanyl 10 mcg/mL started at ICU admission at 5 mL/h and maintained for 24 hours |
IV fentanyl infusion at 8 mcg/kg/h for 24 hours |
| Cheng‐Wei 2017 | TEA PCEA with 0.075% bupivacaine and 2 mcg/mL fentanyl |
Wound infusion with 0.15% bupivacaine infused continuously at 2 mL/h through a catheter embedded in the wound plus IV PCA |
| de Vries 2002 | TEA (T3‐T4) placed immediately before induction of anaesthesia
Test dose with 3 to 4 mL of lidocaine 2% with epinephrine 1:200,000 8 to 10 mL bupivacaine 0.25% with sufentanil 25 mcg/10 mL Bupivacaine 0.125% and sufentanil 25 mcg/50 mL given at 8 to 10 mL/h |
Piritramide 0.2 mg/kg intramuscularly on request |
| Dohle 2001 | TEA (T4‐T5) 18G, midline approach, catheter advanced 3 cm past the needle tip Test dose with 3 mL 2% lidocaine Loading with 8 mL 0.5% bupivacaine injected through the catheter, followed by infusion of 0.25% bupivacaine at the rate of 6 mL/h |
Paravertebral blockade, left T4 to T5, loss of resistance with saline, catheter advanced 3 cm past the needle tip Test dose with 3 mL 2% lidocaine Loading with 8 mL 0.5% bupivacaine injected through the catheter, followed by an infusion of 0.25% bupivacaine at the rate of 6 mL/h |
| El‐Baz 1987 | TEA (T3‐T4), epidural catheter (American Pharmaseal Labs, Glendale, CA, USA) inserted by lateral approach Position of the catheter in the epidural space was confirmed by the catheter advancement test (El‐Baz 1984; "After eliciting a lack of resistance to the injection of air through the epidural needle, the ability to advance 20 cm of a soft epidural catheter, without stylet, beyond the vertebral lamina with minimal resistance was indicative of a successful epidural catheterization. After a successful advancement with minimal resistance, the epidural catheter was withdrawn 17‐18 cm leaving 2 ‐3 cm of the catheter in the epidural space and the tip near the spinal segment (T4 ‐ 5) that corresponded to the site of surgical incision. Subdural and intravascular catheterization were excluded by placing the proximal end of the epidural catheter below the site of injection for gravity drainage to assure the absence of cerebrospinal fluid or blood flow through the catheter") Morphine 0.1 mg/h started in ICU |
IV morphine on request |
| El‐Morsy 2012 | TEA (T3‐T4) inserted at least 2 hours before heparinization (change of level if blood in the needle or catheter) Test dose with 3 mL 1.5% lidocaine 0.125% bupivacaine with 1 mcg/mL fentanyl at 5 mL/h and continued until 24 hours postoperatively |
IV tramadol on demand |
| El‐Shora 2018 | TEA (T6‐T7) catheter inserted through a 17G Tuohy needle with loss of resistance technique Bupivacaine 0.125% plus fentanyl 1 mcg/mL 12 mL followed by 12 mL/h for 48 hours and started after surgery |
Ultrasound‐guided bilateral paravertebral blockade at T6‐T7 Bupivacaine 0.125% plus fentanyl 1 mcg/mL 6 mL per side followed by 6 mL/h for 48 hours and started after surgery |
| Fawcett 1997 | TEA (T2‐T4) inserted in operating room 15 mL bupivacaine 0.5% after CPB Bupivacaine 0.375% at 5 to 8 mL/h for 24 hours |
IV morphine infusion for 24 hours |
| Fillinger 2002 | TEA (T3‐T10), catheter inserted before induction of anaesthesia through an 18G Hustead needle using loss of resistance to saline technique and leaving 3 cm of catheter in the epidural space Test dose with 3 mL 1.5% lidocaine with 1:200,000 epinephrine Loading with morphine 20 mcg/kg and 0.5% bupivacaine in 5‐mg increments, to a total loading dose of 25 to 35 mg bupivacaine 0.5% bupivacaine with morphine 25 mcg/mL at 4 to 10 mL/h beginning after induction of anaesthesia (adjusted on haemodynamic parameters) Epidural catheters removed on the first postoperative day |
Intravenous morphine, intravenous meperidine, and oral oxycodone |
| Greisen 2012 | TEA (T2‐T4) inserted the day before surgery 5 to 7 mL 5.0 mg/mL bupivacaine (Marcaine, Astra, Södertälje, Sweden) together with sufentanil 2.5 mcg/mL Bupivacaine 2.5 mg/mL and sufentanil 1 mcg/mL 4 to 6 mL/h, by discretion of the attending anaesthesiologist, until end of surgery Changed to bupivacaine 1 mg/mL together with sufentanil 1 mcg/mL in ICU and continued after discharge from ICU until second postoperative day |
Not reported |
| Gurses 2013 | CEA (C6‐C7) (Braun Perifix 20 G) inserted 3 to 4 cm caudally (T2‐T4) at least 1 hour before heparin injection 0.075 mg/kg levobupivacaine hydrochloride (Chirocaine 5 mg/mL, Abbott Lab, Istanbul, Turkey) + 2 mcg/kg fentanyl (fentanyl citrate 50 mcg/mL, Abbott Lab, Istanbul, Turkey) in total 10 mL bolus 0.0375 mg/kg/h levobupivacaine + 0.5 mcg/kg/h fentanyl epidural infusion started with patient‐controlled analgesia instrument (Abbott Pain Management Provider, Abbott Laboratoires, North Chicago, IL, USA) |
Intramuscular diclofenac sodium (Dikloron 75 mg 10 amp, Mefar Drug Ltd, Istanbul, Turkey) |
| Hansdottir 2006 | TEA (T2‐T5) inserted the day before surgery using median hanging drop or loss of resistance technique, 3 to 5 cm into the epidural space Test dose with 4 mL lidocaine 1% PCEA with bupivacaine 0.1% and fentanyl 2 mcg/mL |
IV PCA with morphine |
| Heijmans 2007 | TEA (C7‐T1) by median approach and hanging drop technique Test dose of 2 mL lidocaine 2% Loading dose of 10 mL bupivacaine 0.25% with 2.5 mg morphine infused over 1 hour Bupivacaine 0.125% and morphine 0.2 mg/mL at 1.5 mL/h for 48 hours |
IV piritramide 0.15 mg/kg |
| Huh 2004 | TEA (T4‐T5) inserted the day before surgery Test dose with 3 mL lidocaine 2% and epinephrine 5 to 7 mL bupivacaine 0.15% and fentanyl 50 mcg before skin incision Bupivacaine 0.15% and fentanyl 10 mcg/mL through PCEA for 3 days after surgery |
IV meperidine, tramadol, and NSAIDs |
| Hutchenson 2006 | TEA (T2‐T4) inserted 3 cm the day before surgery with fluoroscopic guidance Bupivacaine 0.5% 200 mcg/cm body height Bupivacaine 0.25% 200 mcg/cm body height per hour |
Not reported |
| Jakobsen 2012 | TEA (T3‐T4) Test dose of 3 mL 2% lidocaine Bolus dose of 5 to 7 mL, guided by primary patient heights, of 0.5% bupivacaine (Marcaine; Astra, Södertälje, Sweden) and sufentanil 2.5 mcg/mL Bupivacaine 2.5 mg/mL/sufentanil 1 mcg/mL, 4 to 6 mL/h during surgery Bupivacaine 1 mg/mL and sufentanil 1 mcg/mL postoperatively and continued after discharge from ICU until second postoperative day |
Participants in both groups received intravenous morphine or alfentanil according to the department’s general guidelines (i.e. morphine 0.05 mg/kg, or alfentanil 25 mcg, if rapid pain relief was needed) All participants in both groups received additional oral or intravenous paracetamol 1 g every 6 hours |
| Kendall 2004 | TEA (T1‐T4) inserted after induction through a paramedian approach and loss of resistance technique 2 mL 0.5% bupivacaine plus epinephrine 0.1 mL/kg 0.1% bupivacaine plus fentanyl 5 mcg/mL followed by infusion at 0.1 mL/kg/h kept for 48 hours |
IV PCA with morphine |
| Kilickan 2006 | TEA (T1‐T5) inserted the day before surgery (3 attempts only) Test dose with 3 to 4 mL 2% lidocaine, position confirmed with injection of contrast material and X‐ray Bupivacaine 20 mg after anaesthesia induction Bupivacaine 0.125% 4 to 10 mL/h intraoperatively and postoperatively for 3 days, adjusted for a sensory blockade from T1 to T10 |
IV PCA with morphine |
| Kilickan 2008 | TEA (T1‐T5) inserted the day before surgery (3 attempts only) Test dose with 3 to 4 mL 2% lidocaine, position confirmed with injection of contrast material and X‐ray Bupivacaine 20 mg 60 minutes before induction of anaesthesia Bupivacaine 20 mg/h intraoperatively and postoperatively for 3 days |
IV PCA with Dolantin |
| Kirno 1994 | TEA (T3‐T4; Perifix, B. Braun, Melsungen AG, Germany) at least 12 hours before surgery Mepivacaine 20 mg/mL (Carbocain, Astra, Södertälje, Sweden) was injected to achieve a T1‐T5 block |
Not reported |
| Kirov 2011 | TEA (T2‐T4) Test dose of 1 mL 2% lidocaine Ropivacaine 0.75% 1 mg/kg and fentanyl 1 mcg/kg for surgery Ropivacaine 0.2% and fentanyl 2 mcg/mL at 3 to 8 mL/h (VAS score < 30 mm at rest) or via PCEA after surgery |
IV fentanyl 10 mcg/mL at 3 to 8 mL/h |
| Konishi 1995 | TEA (T7‐T10) inserted the day before surgery Butorphanol 0.5 to 1.0 mg or Morphine 2.5 mg |
Fentanyl, pentazocine, and minor tranquillizers |
| Kundu 2007 | TEA (C7‐T2) inserted 3 to 4 cm cephaladly before anaesthesia induction with hanging drop technique in left lateral decubitus position Lidocaine 1% 5 mL Bupivacaine 0.25% 5 mL plus fentanyl 10 mcg Bupivacaine 0.25% 5 mL plus fentanyl 10 mcg every 2 hours |
Not reported |
| Kunstyr 2001 | TEA (T1‐T5) inserted at least 60 minutes before heparinization 10 mL bupivacaine 0.5% Bupivacaine 0.125% plus sufentanil 1 mcg/mL infused at 3 to 8 mL/h after surgery |
|
| Lenkutis 2009 | TEA (T1‐T2) Lidocaine 2% 7 to 8 mL Bupivacaine 0.25% at 8 mL/h during surgery Bupivacaine 0.25% and fentanyl 5 mcg/mL at 5 to 7 mL/h for at least 84 hours postoperatively |
IM/IV pethidine 0.1 to 0.4 mg/kg |
| Liem 1992 | TEA (T1‐T2) inserted the day before surgery by paramedian approach and hanging drop technique
Test dose with 2 mL 2% lidocaine Loading with 0.375% bupivacaine plus sufentanil 5 mcg/mL at a dose of 0.05 mL/cm body length administered over a 10‐minute period 0.125% bupivacaine plus sufentanil 1 mcg/mL at 0.05 mL/cm body length/h started before induction and continued for 72 hours |
IV nicomorphine |
| Loick 1999 | TEA (C7‐T1) inserted the day before surgery by median approach and hanging drop technique Test dose with 2 mL bupivacaine 0.5% with adrenaline Loading before induction with 8 to 12 mL bupivacaine 0.375% and 16 to 24 mcg sufentanil into the epidural space in increments to block the somatosensory level C7‐T6 PCEA with bupivacaine 0.75% plus sufentanil 1 mcg/mL if < 65 years of age, and without adjuvant if ≥ 65 years (duration unclear, possibly 48 hours) |
PCA with piritramide |
| Lundstrom 2005 | TEA (T1‐T3) inserted the day before surgery by median approach using hanging drop technique Test dose with 2 mL 2% lidocaine Loading with 8 to 10 mL bupivacaine 0.5% (adjusted for sensory block T1‐T8) before induction Bupivacaine 0.125% and morphine 25 mcg/mL at 5 mL/h plus 4 mL every hour started after induction Bupivacaine 0.25% 4 mL on request after surgery (adjusted for T1‐T8) Catheters removed on day 4 or 5 |
Morphine IV for 24 hours, then orally |
| Lyons 1998 | TEA (C7‐T1) Bupivacaine 0.5% 0.1 mL/kg Bupivacaine 0.1% and fentanyl 2 mcg/mL, infusion for 72 hours |
Not reported |
| Mehta 1998 | TEA (T4‐T5 or T5‐T6) 16G, median approach, loss of resistance to saline, catheter inserted 3 to 4 cm past the needle tip On first demand for pain relief, participants in the TEA group received 8 mL 0.25% bupivacaine hydrochloride Maximum of 3 doses was given over the next 12 hours, if required |
Intrapleural catheter: 16G epidural catheter inserted in intercostal space 6 to 7 cm in left anterior axillary line by the operating surgeon, 6 to 8 cm in intrapleural space, directed posteriorly and anchored with a skin suture before thoracotomy closure On first demand for pain relief, participants in the intrapleural group received 20 mL 0.25% bupivacaine hydrochloride Before injection of intrapleural bupivacaine, participants were positioned supine with a one‐third left lateral tilt and with the intercostal chest tube clamped after exclusion of any air leak. The chest tube was kept clamped for 20 minutes after the injection Maximum of 3 doses was given over the next 12 hours, if required |
| Mehta 2008 | TEA (C7‐T1) hanging drop technique in the sitting position, catheter inserted 4 cm beyond needle tip Lidocaine 2% 3 mL Bupivacaine 0.5% 8 mL Bupivacaine 0.25% at 0.1 mL/kg/h |
Paravertebral blockade Loss of resistance to saline at left T4‐T5 Lidocaine 2% 3 mL Bupivacaine 0.5% 8 mL Bupivacaine 0.25% at 0.1 mL/kg/h |
| Mehta 2010 | TEA (C7‐T1) using hanging drop technique in sitting position inserted at least 2 hours before heparinization; intervention postponed in cases of bloody tap 3 mL 2% lidocaine without epinephrine; adequacy and level of the block established by confirming loss of pin‐prick sensation and warm/cold discrimination 8 to 10 mL 0.25% bupivacaine (aim at T4 sensory block) Bupivacaine infusion (0.125%) with fentanyl citrate (1 mcg/mL) at the rate of 5 mL/h was commenced and continued until postoperative day 3 to provide intraoperative and postoperative analgesia |
Not reported |
| Mishra 2004 | No details available | Not reported |
| Moore 1995 | TEA (T1‐T5) Bupivacaine 0.5% in 2 mL increments for sensory block from T1 to L2 Bupivacaine 0.375% at 5 to 8 mL/h started before induction Bupivacaine 0.25% at 5 to 8 mL/h for at least 24 hours |
IV papaveretum |
| Nagaraja 2018 | TEA (C7‐T1) inserted (3 to 4 cm caudally) the day before surgery through an 18G Tuohy needle 0.25% plain bupivacaine 15 mL before surgery followed by 0.125% plain bupivacaine at 0.1 mL/kg/h for 48 hours post extubation |
Ultrasound‑guided (in‐plane) erector spinae plane lock Catherer inserted 5 cm cephaladly the day before surgery through an 18G Tuohy needle. 3 cm lateral to T6 spinous process (T5 transverse process) with hydrodissection below the erector spinae muscle with 5 mL normal saline, 0.25% plain bupivacaine, 15 mL in each catheter before surgery, followed by 0.125% plain bupivacaine at 0.1 mL/kg/h for 48 hours post extubation, through each catheter |
| Neskovic 2013 | TEA (T2‐T4) inserted 30 minutes before surgery and at least 2 hours before the first dose of heparin Test dose 10 to 15 mL 0.125 or 0.25% bupivacaine with fentanyl 0.125 or 0.25% bupivacaine with fentanyl at 5 to 10 mL/h |
Not reported |
| Nygard 2004 | TEA (T1‐T3) inserted the day before surgery by the median approach and hanging drop technique Test dose with 2 mL 2% lidocaine Loading with 8 to 10 mL bupivacaine 05% before induction (adjusted for T1 to T8) Bupivacaine 0.125% with morphine 25 mcg/mL at 5 mL/h started after induction and continued for 4 days Additional bolus doses of 4 mL bupivacaine 0.5% hourly during the operation |
Morphine IV for 24 hours, then orally |
| Obersztyn 2018 | TEA (T1‐T3) with hanging drop technique, catheters inserted 3 to 4 cm into the epidural space at least 6 hours before surgery Before surgery: 9 to 11 mL 0.25% bupivacaine with fentanyl in a concentration of 10 mcg/mL, followed by 0.19% (more exactly, 0.1875%) bupivacaine and fentanyl at 6 mL/h during surgery and 0.125% bupivacaine plus fentanyl 6.25 mcg/mL at 2 to 8 mL/h after surgery until discharge fro the ICU (mean 18.8 hours) |
IV morphine |
| Onan 2011 | TEA (T2‐T4; side‐holed 18 G epidural catheter) by using a median approach and a loss of resistance technique with saline solution Test dose with 3 to 4 mL 2% lidocaine 20 mg bolus 0.25% bupivacaine through the epidural catheters 1 hour before surgery 0.25% bupivacaine infused at a rate of 20 mg/h during surgery 0.125% bupivacaine at 4 to 10 mL/h after surgery (adjusted for T1‐T10) Epidural catheters removed at 24 hours postoperatively |
Not reported |
| Onan 2013 | TEA (T1‐T5) inserted the night before surgery 3 cm into epidural space Test dose with 3 to 4 mL 2% lidocaine Sensory blockade tested with ice plus X‐ray after injection of contrast material Bolus of 20 mg 0.25% bupivacaine 1 hour before surgery 20 mg/h 0.25% bupivacaine intraoperatively Bupivacaine 0.25% 10 to 20 mL/h during first 24 hours after surgery (adjusted according to pain scores) |
Acetaminophen (500 mg) and tramadol (1 mg/kg) used as rescue medications |
| Palomero 2008 | TEA (T3‐T6) inserted the day before surgery Bolus of 6 to 8 mL 0.33% bupivacaine 0.175% bupivacaine 6 to 8 mL/h for 48 hours Catheter withdrawn after check of coagulation status |
Morphine 0.5 to 1 mL/h |
| Petrovski 2006 | TEA; no details | Not reported |
| Priestley 2002 | TEA (T1‐T4; 18G side‐holed epidural catheter) inserted the evening before surgery Test dose with 2% lidocaine 3 to 4 mL Loading with 4 mL ropivacaine 1% and fentanyl 100 mcg (adjusted for T1‐T6) Ropivacaine 1% and fentanyl 5 mcg/mL at 3 to 5 mL/h started before induction and continued for 48 hours |
Continuous morphine infusion for 24 hours, followed by PCA with morphine |
| Rein 1989 | TEA (T4‐T5) Bupivacaine 0.5% 10 mL at induction of anaesthesia and 4 mL every hour during surgery Bupivacaine 0.5% at 4 mL/h for 24 hours |
Morphine |
| Royse 2003 | TEA (T1‐T3) inserted the night before the operation 8 mL bupivacaine 0.5% with fentanyl 20 mcg before induction Ropivacaine 0.2% with fentanyl 2 mcg/mL at 5 to 14 mL/h (for T1‐T10 sensory block) and continued until postoperative day 3, 6H00 AM |
PCA with morphine |
| Scott 2001 | TEA (T2‐T4) inserted before induction Loading with bupivacaine 0.5% 2 boluses of 5 mL (for T1‐T10) Bupivacaine 0.125% and 0.0006% clonidine at 10 L/h started after induction and continued for 96 hours (adjusted on pain scores and sensory block) |
Target controlled infusion of alfentanil for 24 hours followed by PCA with morphine for another 48 hours (adjusted on pain scores) |
| Sen 2017 | TEA (T2‐T4) inserted 4 to 6 cm into epidural space the day before surgery Lidocaine 2% with epinephrine 5 mcg/mL 3 mL Bupivacaine 0.1% and fentanyl 2 mcg/mL at 0.1 mL/kg/h started after induction |
IV fentanyl 0.5 to 2 mcg/kg/h IV tramadol 100 mg as rescue analgesia |
| Sharma 2010 | TEA (C7‐T2) inserted at least 2 hours before heparinization and using hanging drop technique via midline approach Test dose 3 mL 2% lignocaine without epinephrine Loading with 8 to 10 mL bupivacaine 0.25% (for sensory block until at least T4) before induction Bupivacaine 0.125% with 1 mcg/mL fentanyl citrate at 5 mL/h started after induction and continued until third postoperative day |
IV continuous infusion of tramadol |
| Stenseth 1994 | TEA (T4‐T6) inserted the day before surgery Test dose with lidocaine 10 mL bupivacaine 0.5% before induction 4 mL bupivacaine 0.5% hourly during surgery Bupivacaine 0.5% at 3 mL/h plus 4 mL every 4 hours after surgery |
IV morphine on request |
| Stenseth 1996 | TEA (T4‐T6) inserted the day before surgery Test dose with lidocaine 10 mL bupivacaine 0.5% before induction (for at least T1‐T2 block) 4 mL bupivacaine 0.5% hourly during surgery Bupivacaine 0.5% at 3 mL/h plus 4 mL every 4 hours after surgery Morphine epidurally 4 to 6 mg 3 to 4 times a day for the next 2 days, supplemented with bupivacaine 5 mg/mL when needed until third postoperative day |
IV morphine on request |
| Stritesky 2006 | TEA (T2‐T4) 1 hour before surgery with an 18G Tuohy needle and hanging drop or loss of resistance technique, with catheter inserted 4 cm past the needle tip 10 mL bupivacaine 0.25% plus fentanyl 100 mcg for loading (half through the needle and half through the catheter) Bupivacaine 0.25% and fentanyl 1 mcg/mL at 8 to 12 mL/h during surgery and for 48 hours |
Not reported |
| Svircevic 2011 | TEA (T2‐T4) at least 4 hours before heparinization Test dose with lidocaine 2% 3 mL 0.1 mL/kg administered of a solution of 0.08 mg/mL morphine and 0.125% bupivacaine, followed by continuous infusion of 4 to 8 mL/h of the same solution started before induction Epidural catheter removed before transfer to the general ward (median 22 hours) |
Morphine IV infusion |
| Tenenbein 2008 | TEA (T2‐T5) inserted at least 4 hours before systemic heparinization 2.5 mL test dose of 2% lidocaine, with 1:200,000 epinephrine on insertion 3 mL test dose of 2% lidocaine before surgery 0.75% ropivacaine 5 mL with hydromorphone 200 mcg followed by an infusion of ropivacaine 0.75% at 5 mL/h during surgery 0.2% ropivacaine with hydromorphone 15 mcg/mL for 48 hours after surgery |
IV PCA with morphine Indomethacin suppositories (100 mg) postoperatively, and twice‐daily naproxen (500 mg) |
| Tenling 1999 | TEA (T3‐T5; 16G), inserted the day before surgery through the lateral approach and loss of resistance technique with saline 0.9% Test dose of 2 to 3 mL lidocaine 1% 8 to 12 mL bupivacaine 0.5% the morning of the operation (for T1‐T8 sensory block) Bupivacaine 0.5% at 4 to 8 mL/h until ICU admission Bupivacaine 0.2% and sufentanil 1 mcg/mL at 3 to 7 mL/h from arrival to ICU until the day after the operation |
IV ketobemidone |
| Usui 1990 | TEA (T6‐T7) inserted 4 cm past needle tip 24 hours before surgery and kept for 1 or 2 days after extubation Morphine 3 mg given after surgery and repeated as required |
Morphine 10 mg IV as required Additional co‐analgesia as required |
| Volk 2003 | TEA (C7‐T3) inserted the day before surgery Lidocaine 2% for T1‐T6 sensory block Bupivacaine 0.5% 6 to 10 mL hourly during surgery Bupivacaine 0.25% at 6 to 12 mL/h for at least 24 hours |
IV patient‐controlled analgesia with piritramide |
| Yang 1996 | TEA (T4‐T5) inserted 3 cm cephalad in the right lateral decubitus position Lidocaine 2% 3 mL Bupivacaine 0.375% and fentanyl 5 mcg/mL 0.06 mL/cm of body length Bupivacaine 0.25% with fentanyl 5 mcg/mL 0.03 mL/cm of body length every hour |
Not reported |
| Yilmaz 2007 | TEA (T3‐T6) inserted cranially 3 to 4 cm 16 to 24 hours before systemic heparinization (Perifix 18G, Braun) Loading with morphine 5 mcg/kg and 6 mL bupivacaine 0.25% at least 45 minutes before surgical incision 6 mL bupivacaine 0.12% with fentanyl 2.5 mcg/kg every 6 hours for 48 hours, after which catheters were withdrawn |
IV fentanyl 0.7 mcg/kg/h |
| Yung 1997 | TEA or upper lumbar epidural inserted 24 hours before surgery Lidocaine 1.5% 25 to 30 mL with ketamine 15 mg, morphine 1 mg/10 kg for surgery Morhine 1 mg in 10 mL normal saline every 12 hours for 5 days for postoperative analgesia |
IV meperidine HCl |
| Zawar 2015 | TEA (C7‐T2) catheters inserted 4 to 5 cm cranially using hanging drop technique If a “bloody tap” was to occur, the operation was postponed for 24 hours and participant was excluded from the study Bolus of 6 to 14 mL ropivacaine 0.75% for T1‐T10 sensory block (sensory loss to cold pack and needle prick) Infusion of 5 to 15 mL/h ropivacaine 0.2% for 72 hours after surgery |
IV tramadol hydrochloride 100 mg 8 hourly |
| Zhou 2010 | TEA (T4‐T6) inserted in lateral decubitus position the day before surgery Bolus 8 to 20 mL lidocaine 1% PCEA with ropivacaine 0.125% and fentanyl 2 mcg/mL at 4 mL/h plus 2 mL bolus (lockout time 20 minutes) |
IV PCA with fentanyl |
CEA: cervical epidural analgesia; CPB: cardiopulmonary bypass; ICU: intensive care unit; NSAIDs: non‐steroidal anti‐inflammatory drugs; PCA: patient‐controlled analgesia; PCEA: patient‐controlled epidural analgesia; TEA: thoracic epidural analgesia; VAS: visual/verbal analogical pain score.