CRD Summary: This generally well-conducted review concluded that there was no benefit of epidural analgesia on mortality or length of intensive care unit stay and hospital stay, but there may be a reduced duration of mechanical ventilation with thoracic epidural analgesia with local anaesthetics. The conclusion appears likely to be reliable, but is based on small studies of variable quality.

[Included studies used bupivacaine, fentanyl, lidocaine, meperidine, mepivacaine and morphine for epidurals and controls.]

CRD Commentary: The review question was clear and supported by specific inclusion criteria. The authors searched three relevant databases and other relevant sources. The absence of restrictions on the search reduced the chances of language or publication bias being introduced into the review. The authors reported using methods designed to reduce reviewer bias and error in the selection of studies for the review and in the extraction of data, but not in the assessment of validity. The validity assessment used appropriate criteria and was used to inform the synthesis. The decision to use meta-analyses appeared appropriate. Reasonable steps were taken to assess heterogeneity. The authors' conclusions accurately reflected the results of this generally well conducted review. As such they appear likely to be reliable, although the small size and variable quality of the included studies, acknowledged by the authors, should be borne in mind.