Thoracic epidural analgesia is associated with improved recovery after cardiac surgery: a large retrospective cohort study

Thoracic epidural analgesia (TEA) has been proposed as an effective analgesic strategy in cardiac surgery because of its potential beneficial effects on postoperative recovery and organ function. However, concerns regarding complications associated with systemic anticoagulation continue to limit its routine use. This study aimed to compare postoperative respiratory, metabolic, and clinical outcomes between patients receiving TEA and those receiving intravenous analgesia after open-heart surgery. This retrospective single-center cohort study included adult patients who underwent open-heart surgery between January 2009 and December 2021. Patients were divided into two groups according to postoperative analgesia method: thoracic epidural analgesia (Group E) and intravenous analgesia (Group I). Postoperative outcomes, including mechanical ventilation duration, individual respiratory outcomes, postoperative pain scores, analgesic and sedative requirements, laboratory parameters, ICU and hospital length of stay, and mortality, were compared between groups. A total of 1,503 patients were included, including 1,131 in Group E and 372 in Group I. Baseline demographic and surgical characteristics were comparable between groups. Postoperative pain scores were lower in Group E at all evaluated time points during the first 48 h after extubation. After adjustment for baseline covariates, TEA was associated with lower odds of additional analgesic requirement (aOR: 0.59, 95% CI: 0.46–0.77), additional sedative requirement (aOR: 0.48, 95% CI: 0.37–0.62), and NIMV requirement (aOR: 0.52, 95% CI: 0.38–0.71). TEA was also independently associated with shorter mechanical ventilation duration (β = -8.42 h, 95% CI: -9.95 to -6.89) and hospital length of stay (β = -0.94 days, 95% CI: -1.41 to -0.47). Postoperative glucose levels were lower in Group E, while the slight increase in creatinine was not accompanied by differences in renal replacement therapy or mortality. Thoracic epidural analgesia was associated with sustained lower postoperative pain scores, more favorable respiratory outcomes, reduced analgesic and sedative requirements, better glycemic control, and shorter hospital stay following open-heart surgery. These findings suggest that TEA may be associated with improved postoperative recovery as part of multimodal perioperative management in cardiac surgical patients.