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Network meta‐analysis of local and regional analgesia following colorectal resection
Author(s) -
Xu W.,
Varghese C.,
Bissett I. P.,
O'Grady G.,
Wells C. I.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11425
Subject(s) - medicine , analgesic , nausea , opiate , anesthesia , vomiting , meta analysis , randomized controlled trial , surgery , receptor
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.

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