What is the clinical evidence from this study?

Study design: Letter. Population: Myocardial ischemia after aortic surgery. Intervention: Epidural analgesia vs. Intravenous patient-controlled analgesia. Primary outcome: Postoperative myocardial ischemia.

What does this research mean for the field?

Methodological limitations in Bois et al.'s study—including low-risk patient selection, absence of intraoperative epidural blockade, short monitoring duration, and low statistical power—invalidate the conclusion that epidural and intravenous analgesia produce equivalent rates of postoperative myocardial ischemia. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 1, 1998Anesthesia & Analgesia

Epidural Analgesia and Intravenous Patient-Controlled Analgesia Result in Similar Rates of Myocardial Ischemia After Aortic Surgery

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Key result

This letter to the editor critiques a prior study comparing epidural and intravenous patient-controlled analgesia for myocardial ischemia after aortic surgery due to multiple methodological flaws.

Why the study?

Does epidural analgesia reduce postoperative myocardial ischemia compared to intravenous patient-controlled analgesia in patients undergoing aortic surgery?

Population

Patients undergoing aortic surgery

Comparison

Epidural analgesia vs Intravenous patient-controlled analgesia

Design

Editorial

Authors

OLOscar A. de León-CasasolaRoswell Park Comprehensive Cancer Center MLMark J. LemaHospital Universitario Virgen de la Arrixaca

Discussion

Member takes

Implication

This letter highlights significant methodological flaws in a prior study comparing epidural and intravenous analgesia for preventing myocardial ischemia after aortic surgery.

Structured PICO

Does epidural analgesia reduce postoperative myocardial ischemia compared to intravenous patient-controlled analgesia in patients undergoing aortic surgery?

Population

Patients undergoing aortic surgery

Intervention

Epidural analgesia

Comparator

Intravenous patient-controlled analgesia

Outcome

Postoperative myocardial ischemia (POMI)surrogate

This letter highlights significant methodological flaws in a prior study comparing epidural and intravenous analgesia for preventing myocardial ischemia after aortic surgery.

Limitations

Population studied was not at high risk of postoperative cardiac complications
No epidural block used intraoperatively to limit neuroendocrine activation
No intraoperative Holter monitoring used
No measures to guarantee normothermia
Inadequate criteria for diagnosis of non Q wave POMI and unstable angina
Short evaluation period of only 24 hours
Low statistical power
Low-risk population studied
No intraoperative epidural block used
No intraoperative Holter monitoring
Inadequate criteria for non Q wave POMI and unstable angina
Low power of analysis

Cite This Study

León-Casasola et al. (1998) conducted a letter in Myocardial ischemia after aortic surgery. Epidural analgesia vs. Intravenous patient-controlled analgesia was evaluated on Postoperative myocardial ischemia. This letter to the editor critiques a prior study comparing epidural and intravenous patient-controlled analgesia for myocardial ischemia after aortic surgery due to multiple methodological flaws.

synapsesocial.com/papers/6ab8b6c99660f9d384ca58ea https://doi.org/10.1097/00000539-199809000-00058

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Implication

This letter highlights significant methodological flaws in a prior study comparing epidural and intravenous analgesia for preventing myocardial ischemia after aortic surgery.

Epidural Analgesia and Intravenous Patient-Controlled Analgesia Result in Similar Rates of Myocardial Ischemia After Aortic Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Epidural Analgesia and Intravenous Patient-Controlled Analgesia Result in Similar Rates of Myocardial Ischemia After Aortic Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider