6/28/23, 11:16 PM MASTER Anaesthesia Pathway Feedback Search Clinical Topics Home Studies MASTER Anaesthesia MASTER Anaesthesia Disease Postoperative pain Trial question What is the effect of epidural anesthesia and analgesia in high-risk patients undergoing major abdominal surgery? Study design Multi-center Open label RCT Population Characteristics of study participants 41.0% female N = 915 59.0% male 915 patients (371 female, 544 male) Inclusion criteria: high-risk status patients undergoing major abdominal surgery Key exclusion criteria: age < 18 years, surgery within 12 hours of admission to hospital, contraindications to the use of epidural block, infection at the epidural insertion site, or a neurological disorder Interventions N=461 epidural (intraoperative epidural anesthesia and postoperative epidural analgesia for 72 h with general anesthesia) N=454 control (general anesthesia based on a balanced technique with intraoperative and postoperative opioids) https://web.pathway.md/studies/recj5GqGUKPpghYni 1/2 6/28/23, 11:16 PM MASTER Anaesthesia Pathway Primary outcome Death or at least one postsurgical morbidity at 30 days 60.7 % 60.7 57.1 45.5 % 30.4 % 15.2 % No significant difference 0.0 % Epidural Control No significant difference in death or at least one postsurgical morbidity at 30 days (57.1% vs. 60.7%; RR 0.94, 95% CI -0.79 to 2.67) Secondary outcomes No significant difference in death at 30 days (5.1% vs. 4.3%; RR 1.19, 95% CI -4.06 to 6.44) Significant decrease in respiratory failure (23.3% vs. 30.2%; RR 0.77, 95% CI 0.12 to 1.42) No significant difference in cardiovascular event (25.7% vs. 24%; RR 1.07, 95% CI -2.9 to 5.04) Safety outcomes No significant differences in renal failure, gastrointestinal failure, hepatic failure, sepsis, hematological failure,. Significant differences in pain scores on day 1 (11.4 vs. 15.2), day 2 (9.9 vs. 11.9), and day 3 (8.0 vs. 9.7). Conclusion In high-risk status patients undergoing major abdominal surgery, epidural was not superior to control with respect to death or at least one postsurgical morbidity at 30 days. Reference John R A Rigg, Konrad Jamrozik, Paul S Myles et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002 Apr 13;359(9314):1276-82. Open reference URL https://web.pathway.md/studies/recj5GqGUKPpghYni 2/2