Zawar 2015.

Methods	Parallel RCT Ethics committee: approved by hospital research ethics committee Informed consents: written informed consents obtained Site: Institute of Critical Care Anesthesiology, Medanta ‐ The Medicity, Gurgaon, Haryana, India Setting: tertiary care hospital Dates of data collection: between December 2011 and November 2014 Funding: departmental resources Registration: unspecified
Participants	81 participants; mean age: 74.6 years; sex distribution: 9 females and 72 males Inclusion criteria Comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction) Aged ≥ 70 years Undergoing primary off‐pump CABG Exclusion criteria Infection over the spine Coagulation disorders Emergency cases Unstable angina Left main stem disease Dysrhythmia Undergoing combined procedures On intra‐aortic balloon counter‐pulsation On antiplatelet agent Low‐molecular‐weight heparin Heparin infusion
Interventions	Intervention Epidural analgesia (N = 35) Comparator Systemic analgesia (N = 46) Premedication: lorazepam and pantoprazole Induction: thiopentone sodium, fentanyl sulfate, and midazolam Maintenance: isoflurane, fentanyl, midazolam, and pancuronium or vecuronium bromide Surgery: off‐pump CABG
Outcomes	Relevant to this review Risk of myocardial infarction Risk of neurological complications (cerebrovascular accident) Tracheal extubation Pain scores Others Rescue analgesia Markers of inflammation Markers of stress response Blood transfusion requirements Time to mobilization Acute kidney injury ICU length of stay Hospital length of stay
Notes	Correspondence: email sent 16 March 2018; no reply Conflict of interest: no conflicts of interest DOI: 10.4103/0971‐9784.159810
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Participants were randomized by computer‐generated numbers
Allocation concealment (selection bias)	Low risk	Quote: "sealed envelopes"
Blinding of participants and personnel (performance bias) All outcomes	High risk	This was a non‐blinded study
Blinding of outcome assessment (detection bias) All outcomes	High risk	This was a non‐blinded study
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Five protocol violations were reported in participants allocated to the study group. Two epidural catheters were accidentally dislodged during shifting of the participant; 1 participant developed severe hypotension requiring a bolus of epinephrine during catheter placement without any clinical consequences; 1 off‐pump CABG was converted to open CABG due to haemodynamic instability during surgery; and 1 participant withdrew consent from the trial. None of the participants had (quote:) “bloody tap” during epidural catheter placement
Selective reporting (reporting bias)	Low risk	All results reported
Other bias	Low risk	Not in intention‐to‐treat Groups well balanced