Neuraxial block, death and serious cardiovascular morbidity in the POISE trial

Methods. A total of 8351 non-cardiac surgical patients at high risk of cardiovascular complications were randomized to b-blocker or placebo. Neuraxial block was defined as spinal, lumbar or thoracic epidural anaesthesia. Logistic regression, with weighting using estimated propensity scores, was used to determine the association between neuraxial block and primary and secondary outcomes. Results. Neuraxial block was associated with an increased risk of the primary outcome [287 (7.3%) vs 229 (5.7%); odds ratio (OR), 1.24; 95% confidence interval (CI), 1.02 –1.49; P¼0.03] and MI [230 (5.9%) vs 177 (4.4%); OR, 1.32; 95% CI, 1.07–1.64; P¼0.009] but not stroke [23 (0.6%) vs 32 (0.8%); OR, 0.76; 95% CI, 0.44 –1.33; P¼0.34], death [96 (2.5%) vs 111 (2.8%); OR, 0.87; 95% CI, 0.65 –1.17; P¼0.37] or clinically significant hypotension [522 (13.4%) vs 484 (12.1%); OR, 1.13; 95% CI, 0.99 –1.30; P¼0.08]. Thoracic epidural with general anaesthesia was associated with a worse primary outcome than general anaesthesia alone [86 (12.1%) vs 119 (5.4%); OR, 2.95; 95% CI, 2.00 –4.35; P,0.001].