Anestesia combinada general-epidural versus anestesia general, morbimortalidad y eficacia analgésica en cirugía toracoabdominal. Revisión sistemática-metaanálisis

Resumen

Objetivos

Revisión sistemática de ensayos clínicos alea-torizados para comparar anestesia combinada general-epidural seguida de analgesia postoperatoria epidural, con anestesia general seguida de analgesia postoperatoria parenteral pero no epidural, en pacientes intervenidos de cirugía toracoabdominal. Resultados valorados: mortalidad, estancia hospitalaria y en la Unidad de Críticos, analgesia y morbilidad.

Material y métodos

Búsqueda sistemática en bases de datos electrónicas (MEDLINE, EMBASE, The Cochra-ne Controlled Trials Registry y el metaregistro de ensayos clínicos: http://www.controlled-trials.com/mrct/mrct info es.asp). Búsqueda manual a partir de la bibliografía de los artículos. Contacto con autores cuando se juzgó necesario.

Resultados

Analizados un total de 30 estudios (4.294 pacientes). La anestesia combinada mostró ventajas significativas en 2 variables: insuficiencia respiratoria, OR (Odds Ratio) = 0,71 con un IC (intervalo de confianza al 95%) de 0,58 a 0,87, y analgesia del primer día de postoperatorio: diferencia ponderada de medias – 6,91 (IC de – 9,46 a – 4,36). En el resto de variables no se encontraron diferencias significativas.

Conclusiones

La anestesia combinada aporta mejor analgesia y presenta menos casos de insuficiencia respiratoria en el postoperatorio. No se encontraron diferencias significativas en mortalidad, estancias hospitalarias y otras variables de morbilidad.

Summary

Objetives

We performed a systematic review of randomized controlled trials to compare combined general-epidural anesthesia, followed by postoperative epidural analgesia, and general anesthesia followed by postoperative parenteral analgesia without epidural analgesia in patients undergoing thoracoabdominal surgery. Outcome measures considered were mortality, length of stay in hospital and in the intensive care unit, analgesia, and morbidity.

Material and methods

We performed a systematic search of online databases (MEDLINE, EMBASE, the Cochrane Controlled Trials Registry and the metaRegister of clinical trials at http://www.controlled-trials.com/mrct/mrct info es.asp). We also hand-searched the literature. Authors were contacted when deemed necessary.

Results

A total of 30 trials (4294 patients) were analyzed. Combined anesthesia showed significant advantages in relation to 2 variables: respiratory failure (odds ratio, 0.71; 95% confidence interval [CI], 0.58 to 0,87) and analgesia on the first day after surgery (weighted mean difference, - 6.91 95% CI, - 9.46 to - 4.36). No significant differences were found in the other variables.

Conclusions

Combined anesthesia provides better analgesia and is associated with fewer cases of postoperative respiratory failure. No significant differences were found in mortality, length of stay in hospital, or other morbidity variables.