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Epidural versus local anaesthetic infiltration via wound catheters in open liver resection: a meta‐analysis
Author(s) -
Bell Richard,
Pandanaboyana Sanjay,
Prasad K. Raj
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12683
Subject(s) - medicine , cochrane library , meta analysis , anesthesia , surgery , opioid , randomized controlled trial , medline , complication , receptor , political science , law
Abstract Background This meta‐analysis was designed to systematically analyse all published studies comparing local anaesthetic infiltration with wound catheters and epidural catheters in open liver resection. Methods A literature search was performed using the C ochrane C olorectal C ancer G roup C ontrolled T rials R egister, the C ochrane C entral R egister of C ontrolled T rials in the C ochrane L ibrary, MEDLINE , E mbase and S cience C itation I ndex E xpanded. Randomized trials, and prospective and retrospective studies comparing wound catheters with epidural catheters were included. Statistical analysis was performed using Review Manager Version 5.2 software. The primary outcome measures were pain scores in the post‐operative period operation. Secondary outcome measures were hospital stay, time to opening bowels, overall complications and analgesia‐specific complications. Results Four studies including 705 patients were included in the analysis. The pain scores were significantly lower in those patients with epidural on the first post‐operative day ( POD ) (mean difference of −0.90 [−1.29, −0.52], Z = 4.61) ( P < 0.00001) with comparable pain scores on PODs 2 and 3. There was no significant difference in the time to opening bowels, opioid use and hospital stay between the techniques. The post‐operative complication rate was higher in the epidural group (risk ratio 1.40 [1.07, 1.83]; χ 2 = 0.60, df = 1) ( P = 0.44); I 2 = 0%; Z = 2.42 ( P = 0.02). Conclusion Local anaesthetic infiltration via wound catheters combined with patient‐controlled opiate analgesia provides comparable pain relief to epidural catheters except for the first POD . Both techniques are associated with similar hospital stay and opioid use with wound catheters associated with lower complication rate.