A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents*1

Cassady, Joseph F.; Lederhaas, George; Cancel, Dawn D.; Cummings, R. Jay; Loveless, Eric A.

doi:10.1016/s1098-7339(00)90006-3

Cited by 45 publications

(22 citation statements)

References 24 publications

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“…The epidural failure rate at this institution was significantly higher than that reported in the other included studies (22–35% compared to 0%) and when compared to the pediatric scoliosis literature (0–5%) [4–6,12,17,21–24]. In the RCT from this group 22% of epidural patients crossed over to the PCA group.…”

Section: Discussioncontrasting

confidence: 48%

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Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

Stroud

Tulanont

Coates

et al. 2014

Journal of Pediatric Surgery

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Background/Purpose The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER. Methods We searched MEDLINE (1946–2012) and the Cochrane Library (inception–2012) for randomized controlled trials (RCT) and cohort studies comparing epidural analgesia to PCA for postoperative pain management in children following MIPER. We calculated weighted mean differences (WMD) for numeric pain scores and summarized secondary outcomes qualitatively. Results Of 699 studies, 3 RCTs and 3 retrospective cohorts met inclusion criteria. Compared to PCA, mean pain scores were modestly lower with epidural immediately (WMD −1.04, 95% CI −2.11 to 0.03, p = 0.06), 12 hours (WMD −1.12; 95% CI −1.61 to −0.62, p < 0.001), 24 hours (WMD −0.51, 95%CI −1.05 to 0.02, p = 0.06), and 48 hours (WMD −0.85, 95% CI −1.62 to −0.07, p = 0.03) after surgery. We found no statistically significant differences between secondary outcomes. Conclusions Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.

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Section: Discussioncontrasting

confidence: 48%

“…Epidural analgesia and Patient Controlled Analgesia (PCA) are both widely employed techniques for postoperative pain management [6]. PCA has the advantage of allowing patients to titrate the level of medication, balancing analgesia against sedation [7].…”

mentioning

confidence: 99%

Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

Stroud

Tulanont

Coates

et al. 2014

Journal of Pediatric Surgery

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“…2 . Randomization was not clear for one RCT [ 20 ]. Adequate concealment of allocation was clear for three studies [ 21 – 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported VAS score on the second postoperative day [ 17 , 20 – 23 ]. There was no significant heterogeneity (χ 2 = 6.47, df = 4, I 2 = 38 %, P =0.17; Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of patient-controlled epidural analgesia and patient-controlled intravenous analgesia after spinal fusion surgery: a meta-analysis of randomized controlled trials

Tian

2015

BMC Musculoskelet Disord

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BackgroundThe objective of this meta-analysis was to compare the efficacy and safety of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) in postoperative analgesia of spinal fusion surgery.MethodsPotential academic articles were identified from the Cochrane Library, Medline (1966–2015.5), PubMed (1966–2015.5), Embase (1980–2015.5) and ScienceDirect (1966–2015.5). Gray studies were identified from the references of the included literature. Randomized controlled trials (RCTs) involving PCEA and PCIA after spinal fusion were included. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Fixed or random effects model was used for meta-analysis.ResultsEight RCTs met the inclusion criteria. There was a better analgesic effect in patients with PCEA for postoperative VAS on the first day (P = 0.0005) and second day (P = 0.006). The patients with PCEA had a higher incidence of pruritus (P = 0.02) and paresthesia (P = 0.03) after surgery than those with PCIA. There was no statistically significant difference in postoperative VAS on the third day (P = 0.15), nausea (P = 0.74) or emesis (P = 0.37) between the two groups.ConclusionsAfter spinal fusion, the patients with PCEA have similar analgesic efficacy during the three postoperative days and a higher incidence of pruritus and paresthesia than those with PCIA. Due to the limited quality and data of the evidence currently available, more high-quality randomized controlled trials are required.

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“…Postsurgery pain is a major medial challenge for patients and clinical staff and results in physical discomfort, psychological harm, and hormonal disturbances 1 . The major causes for postsurgery pain are tissue injury, residual pneumoperitoneum, and phrenic neuropraxia 2 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of multimodal analgesic techniques for preventing chronic postsurgery pain under different surgical categories: a meta-analysis

Zhou

Fan

Zhong

et al. 2017

Sci Rep

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The purpose of this meta-analysis was to compare the efficacy and safety of regional anesthesia to manage chronic postsurgery pain. A systematic search of PubMed, EmBase, and the Cochrane Central Register of Controlled Trials was performed to identify randomized controlled trials that focused on chronic pain frequency, analgesic consumption, and adverse effects under different surgical categories. We collected 21 trials assessing 1,980 patients for our meta-analysis. The summary of relative risks (RRs) and standard mean differences (SMDs) were calculated to measure the treatment effect of regional anesthesia. Results indicated that regional anesthesia significantly reduced the frequency of postsurgery pain (RR, 0.69; 95% confidence interval [CI], 0.56–0.85; p < 0.001). The results showed significant differences in overall patient satisfaction between applications with and without regional anesthesia (SMD, 1.95; 95%CI, 0.83–3.06; p = 0.001); however in other results, there were no significant differences between the two groups. Subgroup analysis suggested that regional anesthesia treatment might differ according to country. In conclusion, our study indicated that regional anesthesia was effective and safe in reducing the frequency of postsurgery pain and improved overall patient satisfaction; however, studies on the long-term efficacy and safety of regional anesthesia are still required to further confirm these findings.

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A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents*1

Abstract: Continuous epidural analgesia and patient-controlled analgesia are comparably effective and safe after posterior spinal fusion. Return of bowel sounds occurred significantly more rapidly in patients receiving CEA postoperatively.

Cited by 45 publications

References 24 publications

Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

Comparison of patient-controlled epidural analgesia and patient-controlled intravenous analgesia after spinal fusion surgery: a meta-analysis of randomized controlled trials

Efficacy and safety of multimodal analgesic techniques for preventing chronic postsurgery pain under different surgical categories: a meta-analysis

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