Effects of Epidural Analgesia on Prognosis after Intestinal Surgery: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIA Haifa , REN Xuli , WANG Shaoshuang ,  LV Huangwei

Department of Anesthesiology, the First Affiliated Hospital, China Medical University, Shenyang 110001, China;

Corresponding author：

LV Huangwei, Email: hwl1998@yahoo.com

Keywords：

Epidural analgesia; Intestinal surgery; Meta-analysis

DOI：

10.7507/1672-2531.20110158

Video：

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Objective 　To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery.
Methods 　Such databases as PubMed, EBSCO, Springer, Ovid and CNKI were searched to identify randomized controlled trials (RCTs) about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook, and then the meta-analyses were conducted by using RevMan 5.0 software.
Results 　Ten RCTs involving 506 patients were included. The results of meta-analyses showed that compared with the patient controlled analgesia (PCA), the patient controlled epidural analgesia (PCEA) significantly reduced the waiting time for having first flatus, first defecation, and the length of hospital stay (MD= –1.07, 95%CI –1.63 to –0.50; MD= –0.63, 95%CI –1.19 to –0.08; MD= –1.36, 95%CI –2.28 to –0.44; respectively), lowered the frequency of vomiting on the first and second day after operation (OR=0.33, 95%CI 0.13 to 0.82; OR=0.3, 95%CI 0.13 to 0.84; respectively), and obviously declined the visual analog scale (VAS) scores of rest pain on the first, second and third day after operation (MD= –26.60, 95%CI –33.06 to –20.15; MD= –25.98, 95%CI –30.98 to –20.97; MD= –15.59, 95%CI –27.29 to –3.88; respectively), and the VAS scores of motion pain on the first, second and third day after operation (MD= –26.00, 95%CI –36.00 to –16.00; MD= –27.89, 95%CI –35.70 to –20.08; MD= –11.79, 95%CI –21.28 to –2.30; respectively). There were no significant differences between the two groups in the incidence of urinary tract infection, urinary retention, anastomotic leak and ileus.
Conclusion 　PCEA significantly reduces the waiting time for having first flatus and first feces, the length of hospital stay, the VAS scores of pain, and the incidence of postoperative vomiting.

Citation： XIA Haifa,REN Xuli,WANG Shaoshuang,LV Huangwei. Effects of Epidural Analgesia on Prognosis after Intestinal Surgery: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(8): 946-953. doi: 10.7507/1672-2531.20110158 Copy

1.	1 Cali RL, Meade PG, Swanson MS, et al . Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum , 2000, 43(2): 163-168.
2.	Liu S, Carpenter RL, Neal JM, et al . Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology , 1995, 82(6): 1474-1506.
3.	Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci , 1990, 35: 121-131.
4.	Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surgery , 2003, 238(5): 663-673.
5.	Rockemann MG, Seeling W, Goertz AW, et al . Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient-controlled analgesia (PCA). Anasthesiol Intensivmed Notfallmed Schmerzther , 1997, 32(7): 414-419.
6.	Thompson JS. The role of epidural analgesia and anesthesia in surgical outcomes. Adv Surg , 2002, 36(4): 297-307.
7.	Waurick R, Van AH. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol , 2005, 19(2): 201-213.
8.	ParkWY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg , 2001, 234(4): 560-569.
9.	Peyton PJ, Myles PS, Silbert BS, et al . Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg , 2003, 96(2): 548-554.
10.	Urs Z, Danilo M, Christian T, et al . Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection. Surg Endosc , 2009, 23(2): 276-282.
11.	Taqi X, Hong G, Mistraletti G, et al . 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 , 2007, 21(2): 247-252.
12.	Carli F, Mayo N, Klubien K, et al . Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology , 2002, 97(3): 540-549.
13.	Paulsen EK, Porter MG, Helmer SD, et al . Thoracic epidural versus patient-controlled analgesia in elective bowel resections. The American Journal of Surgery , 2007, 182(6): 570-577.
14.	Carli F, Trudel JL, Belliveau P, et al . The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective randomized trial. Dis Colon Rectum , 2001, 44(8): 1083-1089.
15.	Claude M, Yvan P, Gilles B, et al . Comparison of Intravenous or Epidural Patientcontrolled Analgesia in the Elderly after Major Abdominal Surgery. Anesthesiology , 2000, 92(2): 433-441.
16.	李芳, 孔德玲, 赵道霞. PCIA 与PCEA 对下腹部手术后患者功能恢复影响的对比研究. 山西医科大学学报, 2007, 38(9): 842-844.
17.	徐红梅, 张跃, 钱燕宁. 贲门癌根治术中两种麻醉镇痛方案对病人术后康复的影响及其医疗费用比较. 实用临床医药杂志, 2008, 12(7): 37-42.
18.	洪溪, Carli F, 黄宇光, 等. 手术及镇痛方式对肠道手术后功能恢复的影响. 临床麻醉学杂志, 2006, 22(5): 334-336.
19.	王刚, 江志伟, 沈蓓, 等. 胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛和肠功能的影响. 医学研究生学报, 2010, 23(8): 830-833.
20.	刘建湘, 刘新光. 外科手术后的胃肠动力障碍. 中国实用内科杂志, 2001, 21(10): 591-593.
21.	刘志双, 李星, 刘顺锁, 等. 剖宫产手术后硬膜外腔持续镇痛效果及对泌乳和肠蠕动的影响. 中华麻醉学杂志, 2003, 23(1): 64-65.
22.	Scott AM, Starling JR, Ruscher AE. Thoracic versus lumbar epidural anesthesia’s effect on pain control and ileus resolustion after restorative proctocolectomy. Surgery , 1996, 120(4): 688-697.
23.	Bredtmann RD, Herden HN, Teichmann W, et al . Epidural analgesia in colonic surgery: results of a randomized prospective study. Br J Surg , 1990, 77(6): 638-642.

1. 1 Cali RL, Meade PG, Swanson MS, et al . Effect of morphine and incision length on bowel function after colectomy. Dis Colon Rectum , 2000, 43(2): 163-168.
2. Liu S, Carpenter RL, Neal JM, et al . Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology , 1995, 82(6): 1474-1506.
3. Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci , 1990, 35: 121-131.
4. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surgery , 2003, 238(5): 663-673.
5. Rockemann MG, Seeling W, Goertz AW, et al . Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient-controlled analgesia (PCA). Anasthesiol Intensivmed Notfallmed Schmerzther , 1997, 32(7): 414-419.
6. Thompson JS. The role of epidural analgesia and anesthesia in surgical outcomes. Adv Surg , 2002, 36(4): 297-307.
7. Waurick R, Van AH. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol , 2005, 19(2): 201-213.
8. ParkWY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg , 2001, 234(4): 560-569.
9. Peyton PJ, Myles PS, Silbert BS, et al . Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg , 2003, 96(2): 548-554.
10. Urs Z, Danilo M, Christian T, et al . Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection. Surg Endosc , 2009, 23(2): 276-282.
11. Taqi X, Hong G, Mistraletti G, et al . 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 , 2007, 21(2): 247-252.
12. Carli F, Mayo N, Klubien K, et al . Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology , 2002, 97(3): 540-549.
13. Paulsen EK, Porter MG, Helmer SD, et al . Thoracic epidural versus patient-controlled analgesia in elective bowel resections. The American Journal of Surgery , 2007, 182(6): 570-577.
14. Carli F, Trudel JL, Belliveau P, et al . The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective randomized trial. Dis Colon Rectum , 2001, 44(8): 1083-1089.
15. Claude M, Yvan P, Gilles B, et al . Comparison of Intravenous or Epidural Patientcontrolled Analgesia in the Elderly after Major Abdominal Surgery. Anesthesiology , 2000, 92(2): 433-441.
16. 李芳, 孔德玲, 赵道霞. PCIA 与PCEA 对下腹部手术后患者功能恢复影响的对比研究. 山西医科大学学报, 2007, 38(9): 842-844.
17. 徐红梅, 张跃, 钱燕宁. 贲门癌根治术中两种麻醉镇痛方案对病人术后康复的影响及其医疗费用比较. 实用临床医药杂志, 2008, 12(7): 37-42.
18. 洪溪, Carli F, 黄宇光, 等. 手术及镇痛方式对肠道手术后功能恢复的影响. 临床麻醉学杂志, 2006, 22(5): 334-336.
19. 王刚, 江志伟, 沈蓓, 等. 胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛和肠功能的影响. 医学研究生学报, 2010, 23(8): 830-833.
20. 刘建湘, 刘新光. 外科手术后的胃肠动力障碍. 中国实用内科杂志, 2001, 21(10): 591-593.
21. 刘志双, 李星, 刘顺锁, 等. 剖宫产手术后硬膜外腔持续镇痛效果及对泌乳和肠蠕动的影响. 中华麻醉学杂志, 2003, 23(1): 64-65.
22. Scott AM, Starling JR, Ruscher AE. Thoracic versus lumbar epidural anesthesia’s effect on pain control and ileus resolustion after restorative proctocolectomy. Surgery , 1996, 120(4): 688-697.
23. Bredtmann RD, Herden HN, Teichmann W, et al . Epidural analgesia in colonic surgery: results of a randomized prospective study. Br J Surg , 1990, 77(6): 638-642.

Chinese Journal of Evidence-Based Medicine

Effects of Epidural Analgesia on Prognosis after Intestinal Surgery: A Meta-analysis

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