Network meta-analysis of local and regional analgesia following colorectal resection

Abstract

Background Postoperative pain management after colorectal surgery remains challenging. Systemic opiates delivered on demand or via a patient‐controlled pump have traditionally been the mainstay of treatment. Opiate analgesia is associated with slower gastrointestinal recovery and unpleasant side‐effects; many regional and local analgesic techniques have been developed as alternatives. Methods MEDLINE, Embase and CENTRAL databases were searched systematically for RCTs comparing analgesic techniques after major colorectal resection. A network meta‐analysis was performed using a Bayesian random‐effects framework with a non‐informative prior. Primary outcomes included pain at rest and cumulative opiate consumption 24 h after surgery. Secondary outcomes included pain at rest and cumulative opiate consumption at 48 h, pain on movement and cough at 24 and 48 h, time to first stool, time to tolerance of oral diet, duration of hospital stay, nausea and vomiting, and postoperative complications. Results Seventy‐four RCTs, including 5101 patients and 11 different techniques, were included. Some inconsistency and heterogeneity was found. SUCRA scores showed that spinal analgesia was the best intervention for postoperative pain and opiate reduction at 24 h. Transversus abdominus plane blocks were effective in reducing pain and opiate consumption 24 h after surgery. Subgroup analysis showed similar results for open versus minimally invasive surgical approaches, and enhanced recovery after surgery programmes. Conclusion Spinal analgesia and transversus abdominus plane blocks best balanced pain control and opiate minimization in the immediate postoperative phase following colorectal resection. Multimodal analgesia reduces pain, minimizes systemic opiate use and optimizes postoperative recovery.

Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids

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Intravenous Local Anesthetic Compared With Intraperitoneal Local Anesthetic in Laparoscopic Colectomy

“…The basic accepted principles for multimodal analgesia are the relief of pain while reducing opioid consumption and potential risk/side effects from the medications. 19 This study aimed to examine 2 components of a multimodal analgesia regimen by comparing 2 possible routes of administering local anesthetic to find out which technique should be incorporated in the analgesia regimes. This study showed a significant reduction of opioid consumption, but similar pain scores, in the IPL group when compared to the IVL group.…”

Effect of liposomal bupivacaine on opioid requirements and length of stay in colorectal enhanced recovery pathways: A systematic review and network meta‐analysis

“…In a recent network meta-analysis, Xu et al [44] compared local and regional anaesthetic techniques in colorectal patients, demonstrating the superiority of TAP blocks and spinal anaesthesia over other techniques. Given the findings by Xu et al, the potential to prolong the effect of TAP blocks using LB would be particularly advantageous.…”