The Effects of Adjunctive Thoracic Epidural Blockade Therapy in Patients with Heart Failure: A Systematic Review and Cumulative Meta-Analysis of Open-Label Trials

Background: Accumulative evidences have revealed the cardiac protective effects of thoracic epidural blockade (TEB), an anesthetic and analgesic method widely used in medical practice. However, TEB doesnu0027t receive worldwide consensus in heart failure (HF) treatment. Thus, we conducted the current systematic review and cumulative meta-analysis to evaluate the therapeutic effects of adjunctive TEB in patients with HF.Methods: We conducted searches of the published literature in MEDLINE, PsycINFO, Scopus, EMBASE, CENTRAL, CNKI, VIP, WanFang databases from inception to October 2014. Clinical trials that studied adjunctive TEB in HF treatment were analyzed. Effect sizes were summarized using odds ratio (OR) or weighted mean differences (WMDs) by suitable effect model, and secondary findings in each trial were comprehensively reviewed.Results: Eighteen eligible trials with 1076 subjects were identified. Benefits of adjunctive TEB in HF treatment were shown on improving New York Heart Association (NYHA) class (OR, 11.39; 95% confidence interval [CI], 6.41 to 20.24, Pu003c0.00001), left ventricular ejection fraction (LVEF, WMD, 8.45%; 95% CI, 6.48 to 10.41, Pu003c0.00001) and left ventricular end-diastolic diameters (LVEDd, WMD, -4.39 mm; 95% CI, -5.95 to -2.83, Pu003c0.00001). The secondary findings of cardiac function and structure improvement in all trials were reported dominantly advantageous. No TEB-related serious adverse events were reported in these included trials.Conclusions: Present data support that adjunctive TEB might be a promising candidate for HF. However, the pooled results might be weakened by the study design, suggesting that further randomized controlled trials are needed.  Citation: Huang-Hui Wu, Hai-Yan Wang, Xiao-Hui Tan, Da-Xiu Wei, Hui-Hua Ke, Yan Zhang, et al. The effects of adjunctive thoracic epidural blockade therapy in patients with heart failure: a systematic review and cumulative meta-analysis of open-label trials. J Anesth Perioper Med 2015; 2: 301-15. doi: 10.24015/JAPM.2015.0041This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.