Thoracic epidural analgesia (TEA) versus patient-controlled analgesia (PCA) in laparoscopic colectomy: a systematic review and meta-analysis
- 254 Downloads
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.
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.
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.
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.
KeywordsTEA PCA Laparoscopic colectomy Meta-analysis
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O, Enhanced Recovery After Surgery Society (2012) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr 31:783–800. https://doi.org/10.1016/j.clnu.2012.08.013 CrossRefPubMedGoogle Scholar
- 7.Zhuang C-L, Huang D-D, Chen F-F, Zhou C-J, Zheng B-S, Chen B-C, Shen X, Yu Z (2015) Laparoscopic versus open colorectal surgery within enhanced recovery after surgery programs: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc 29:2091–2100. https://doi.org/10.1007/s00464-014-3922-y CrossRefPubMedGoogle Scholar
- 8.Spanjersberg WR, van Sambeeck JDP, Bremers A, Rosman C, van Laarhoven CJHM (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453. https://doi.org/10.1007/s00464-015-4148-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Borzellino G, Francis NK, Chapuis O, Krastinova E, Dyevre V, Genna M (2016) Role of epidural analgesia within an ERAS program after laparoscopic colorectal surgery: a review and meta-analysis of randomised controlled studies. Surg Res Pract 2016:1–9. https://doi.org/10.1155/2016/7543684 CrossRefGoogle Scholar
- 10.Cummings KC III, Zimmerman NM, Maheshwari K, Cooper GS, Cummings LC (2018) Epidural compared with non-epidural analgesia and cardiopulmonary complications after colectomy: a retrospective cohort study of 20,880 patients using a national quality database. J Clin Anesth 47:12–18. https://doi.org/10.1016/j.jclinane.2018.03.005 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Steele SR, Feldman LS (2017) Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 31:3412–3436. https://doi.org/10.1007/s00464-017-5722-7 CrossRefPubMedGoogle Scholar
- 13.Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F (2007) Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc Other Interv Tech 21:247–252. https://doi.org/10.1007/s00464-006-0069-5 CrossRefGoogle Scholar
- 14.Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U (2009) Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surg Endosc 23:276–282. https://doi.org/10.1007/s00464-008-9888-x CrossRefPubMedGoogle Scholar
- 16.Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Neudecker J, Schwenk W, Junghans T, Pietsch S, Böhm B, Müller JM (1999) Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg 86:1292–1295. https://doi.org/10.1046/j.1365-2168.1999.01242.x
- 20.Turunen P, Carpelan-Holmstrom M, Kairaluoma P, Wikstrom H, Kruuna O, Pere P, Bachmann M, Sarna S, Scheinin T (2009) Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study. Surg Endosc 23:31–33. https://doi.org/10.1007/s00464-008-0100-0 CrossRefPubMedGoogle Scholar
- 21.Wongyingsinn M, Baldini G, Charlebois P, Liberman S, Stein B, Carli F (2011) Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Reg Anesth Pain Med 36:241–248. https://doi.org/10.1097/AAP.0b013e31820d4362 CrossRefPubMedGoogle Scholar
- 22.Hubner M, Blanc C, Roulin D, Winiker M, Gander S, Demartines N (2015) Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg 261:648–653. https://doi.org/10.1097/SLA.0000000000000838 CrossRefPubMedGoogle Scholar
- 24.Watt DG, McSorley ST, Horgan PG, McMillan DC (2015) Enhanced recovery after surgery: which components, if any, impact on the systemic inflammatory response following colorectal surgery: a systematic review. Medicine (Baltimore) 94:e1286. https://doi.org/10.1097/MD.0000000000001286 CrossRefGoogle Scholar
- 25.Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, Roche AM, Eisenstein EL, Edwards R, Anstrom KJ, Moon RE, Gan TJ, Enhanced Recovery Study Group (2014) Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 118:1052–1061. https://doi.org/10.1213/ANE.0000000000000206 CrossRefPubMedGoogle Scholar
- 27.Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, Gan TJ, Kennedy RH, Ljungqvist O, Lobo DN, Miller T, Radtke FF, Ruiz Garces T, Schricker T, Scott MJ, Thacker JK, Ytrebø LM, Carli F (2016) Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60:289–334. https://doi.org/10.1111/aas.12651 CrossRefPubMedGoogle Scholar
- 36.Levy BF, Tilney HS, Dowson HMP, Rockall TA (2010) A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Color Dis 12:5–15. https://doi.org/10.1111/j.1463-1318.2009.01799.x
- 40.Choi JB, Shim YH, Lee Y-W, Lee JS, Choi J-R, Chang CH (2014) Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis. Yonsei Med J 55:1430–1435. https://doi.org/10.3349/ymj.2014.55.5.1430 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Koh JC, Lee J, Kim SY, Choi S, Han DW (2015) Postoperative pain and intravenous patient-controlled analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 10,575 patients. Medicine (Baltimore) 94:e2008. https://doi.org/10.1097/MD.0000000000002008 CrossRefGoogle Scholar
- 43.Koh JC, Song Y, Kim SY, Park S, Ko SH, Han DW (2017) Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients. J Pain Res Volume 10:897–904. https://doi.org/10.2147/JPR.S133235 CrossRefGoogle Scholar
- 46.daSilva M, Lomelin D, Tsui J, Klinginsmith M, Tadaki C, Langenfeld S (2015) Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia. Tech Coloproctol 19:515–520. https://doi.org/10.1007/s10151-015-1336-z CrossRefPubMedGoogle Scholar
- 48.Koo KC, Yoon YE, Chung BH, Hong SJ, Rha KH (2014) Analgesic opioid dose is an important indicator of postoperative ileus following radical cystectomy with ileal conduit: experience in the robotic surgery era. Yonsei Med J 55:1359–1365. https://doi.org/10.3349/ymj.2014.55.5.1359 CrossRefPubMedPubMedCentralGoogle Scholar