Konstantinos Perivoliotis1, Chamaidi Sarakatsianou2, Stavroula Georgopoulou2, George Tzovaras1, Ioannis Baloyiannis3. 1. Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece. 2. Department of Anaesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece. 3. Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece. balioan@hotmail.com.
Abstract
PURPOSE: A meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy. METHODS: Our study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Fixed effects (FE) or random effects (RE) models were estimated based on the Cochran Q test result. RESULTS: Totally, 8 studies were introduced in the present meta-analysis. Superiority of PCA in terms of length of hospital stay (LOS) (WMD 0.73, p = 0.004) and total complication rate (OR 1.57, p = 0.02) was found. TEA had a lower resting pain visual analogue scale (VAS) score at Day 1 (WMD - 2.23, p = 0.005) and Day 2 (WMD - 2.17, p = 0.01). TEA group had also a systematically lower walking VAS. Moreover, first bowel opened time (first defecation) (WMD - 0.88, p < 0.00001) was higher when PCA was applied. CONCLUSIONS: TEA was related to a lower first bowel opened time, walking, and resting pain levels at the first postoperative days. However, the overall complication rate and LOS were higher in the epidural analgesia group. Thus, for a safe conclusion to be drawn, further randomized controlled trials (RCTs) of a higher methodological and quality level are required.
PURPOSE: A meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy. METHODS: Our study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Fixed effects (FE) or random effects (RE) models were estimated based on the Cochran Q test result. RESULTS: Totally, 8 studies were introduced in the present meta-analysis. Superiority of PCA in terms of length of hospital stay (LOS) (WMD 0.73, p = 0.004) and total complication rate (OR 1.57, p = 0.02) was found. TEA had a lower resting pain visual analogue scale (VAS) score at Day 1 (WMD - 2.23, p = 0.005) and Day 2 (WMD - 2.17, p = 0.01). TEA group had also a systematically lower walking VAS. Moreover, first bowel opened time (first defecation) (WMD - 0.88, p < 0.00001) was higher when PCA was applied. CONCLUSIONS:TEA was related to a lower first bowel opened time, walking, and resting pain levels at the first postoperative days. However, the overall complication rate and LOS were higher in the epidural analgesia group. Thus, for a safe conclusion to be drawn, further randomized controlled trials (RCTs) of a higher methodological and quality level are required.
Authors: Pertti Turunen; Monika Carpelan-Holmström; Pekka Kairaluoma; Heidi Wikström; Olli Kruuna; Pertti Pere; Martina Bachmann; Seppo Sarna; Tom Scheinin Journal: Surg Endosc Date: 2008-09-24 Impact factor: 4.584
Authors: Chamaidi Sarakatsianou; Konstantinos Perivoliotis; George Tzovaras; Athina A Samara; Ioannis Baloyiannis Journal: In Vivo Date: 2021 Nov-Dec Impact factor: 2.155
Authors: Vilma Bumblyte; Suvi K Rasilainen; Anu Ehrlich; Tom Scheinin; Vesa K Kontinen; Aino Sevon; Heikki Vääräniemi; Alexey A Schramko Journal: Surg Endosc Date: 2021-09-03 Impact factor: 4.584