Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Radovanović, Dragana; Radovanović, Zoran; Skoric-Jokic, Svetlana; Tatic, Milanka; Mandić, Aljoša; Ivković-Kapicl, Tatjana

doi:10.20471/acc.2017.56.02.07

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…Eleven studies investigated epidural analgesia against patient controlled analgesia with morphine, with a pooled total of 2494 patients 7778798081828384858687. The quality of the evidence was low.…”

Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

135

120

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OBJECTIVE To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGNSystematic review and meta-analysis of randomised controlled trials. DATA SOURCESMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIARandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESISReviewers independently identified studies, extracted data, and assessed the quality of evidence. Metaanalyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONSPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGIS...

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Section: Resultsmentioning

confidence: 99%

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Odor

Bampoe

Gilhooly

et al. 2020

BMJ

135

120

View full text Add to dashboard Cite

show abstract

“…Finally, we retained 11 RCTs [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] and one systematic review with meta-analysis [ 2 ] that met inclusion and exclusion criteria published between 2007 and 2018. Forty-four studies were excluded with reasons: six studies were meta-analysis including rectal resection [ 9 , [26] , [27] , [28] , [29] , [30] ], seven RCTs including patients undergoing only open colorectal surgery [ [31] , [32] , [33] , [34] , [35] , [36] , [37] ], four RCTs were included in the retained meta-analysis [ [38] , [39] , [40] , [41] ], twenty RCTs assessed rectal surgery, one RCT compared two different approaches of the same analgesic technique [ 42 ] and four non-randomized trials [ [43] , [44] , [45] , [46] ]. Table 1 , Table 2 summarise the included meta-analysis and RCTs.…”

Section: Resultsmentioning

confidence: 99%

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

Daghmouri

Chaouch

Oueslati

et al. 2021

Annals of Medicine and Surgery

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Introduction Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients. Methods We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine. Results Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia. Conclusions Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228).

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“…In addition, thoracic epidural analgesia positively impacts on intestinal recovery, dietary intake, quality of life and mortality rate after major abdominal surgery [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Thoracic epidurals in adults 97 www.anesth-pain-med.org group (3[2,4] vs. 4[3,5] on postoperative day 1, P < 0.001, and 2[2,3] vs. 3[2,4] on postoperative day 3, P = 0.002]). The postoperative pain scores were significantly lower in the awake group compared to the anesthetized group on days 1 and 3 after colon surgery (3[2,4] vs. 4[3,5] on postoperative day 1, P < 0.001 and 2[2,3] vs. 3[3,5] on postoperative day 3, P = 0.005).…”

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confidence: 99%

A clinical retrospective study comparing thoracic epidural catheterization between awake and anesthetized patients

Lee

Cho

et al. 2019

Anesth Pain Med

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Background: The clinical outcomes and safety of thoracic epidural catheterization in anesthetized adult patients has not yet been established. The purpose of this study was to compare clinical differences between epidural catheterization performed before and after anesthesia for postoperative pain control. Methods:The medical records of 549 patients who received thoracic epidural catheterization before (awake group, n = 303) or after (anesthetized group, n = 246) induction of anesthesia for major abdominal surgery were reviewed retrospectively. Results:The catheter insertion time (1.6 ± 1.5 vs. 1.1 ± 1.2 min; 95% confidence interval [95% CI], 0.3-0.8; effect size, 0.368; P < 0.001) and number of attempts required for successful epidural catheterization (1 [1, 3] vs. 1 [1, 2], P = 0.003) were increased in the awake group. The incidence rates of dural puncture, vascular injury and postoperative paresthesia were similar between the two groups. The median surgical site numerical rating scale pain score (0 = no pain, 10 = worst pain imaginable) was lower in the awake group than in the anesthetized group (3 vs. 4 on postoperative day 1, P < 0.001; and 2 vs. 3 on postoperative day 3, P = 0.002). Serious complications, including meningitis, epidural abscess, epidural hematoma, spinal cord injury, and paraplegia, were not observed in either group.Conclusions: Successful epidural catheterization before induction of anesthesia required more attempts versus after anesthesia. Overall complication rates of thoracic epidural catheterization were similar regardless of the timing of the procedure.

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Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Cited by 22 publications

References 32 publications

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

A clinical retrospective study comparing thoracic epidural catheterization between awake and anesthetized patients

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