Epidural versus intravenous analgesia following radical gastrectomy for gastric cancer: A systematic review and Meta-analysis
10.3760/cma.j.cn115396-20191118-00216
- VernacularTitle:胃癌术后硬膜外镇痛与静脉镇痛对比的系统回顾与Meta分析
- Author:
Jie CHEN
1
;
Bo LIAN
;
Dan SONG
;
Shuai XU
;
Xiaotian SONG
;
Qingchuan ZHAO
Author Information
1. 空军军医大学西京消化病医院消化外科国家消化系统疾病临床医学研究中心，西安 710032
- From:
International Journal of Surgery
2020;47(4):255-261,290
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the application of epidural analgesia (EA) with intravenous analgesia (IA) in radical gastrectomy for gastric cancer.Methods:A systematic review and meta-analysis of randomized controlled trials of EA and IA in radical gastrectomy was conducted. Primary outcome was pain scores at 24 h after surgery, while the secondary outcomes included incidence of postoperative complications, first flatus time and (LOS).Results:A total of 6 randomized controlled studies was identified and 393 patients were enrolled in this review, 4 published in English and 2 in Chinese. Meta-analysis revealed that, the EA group had lower pain score at 24h either pain at rest ( WMD=-0.74, 95% CI: -1.35~-0.13, P=0.02) or pain on movement or coughing( WMD=-1.5, 95% CI: -1.95~-1.05, P<0.001) than that of the IA group. In terms of complications, postoperative nausea and vomiting ( RR=0.32, 95% CI: 0.18~0.58, P<0.001) and respiratory complications ( RR=0.50, 95% CI: 0.29~0.85, P=0.01) in EA group were obviously lower than those of the IA group. No difference was observed in postoperative urinary complications between the two groups ( RR=0.87, 95% CI: 0.38~1.96, P=0.73). However, the incidence of hypotension was obviously higher than that of IA group ( RR=3.27, 95% CI: 1.28~8.32, P=0.01). Time of first exhaust time after operation ( WMD=-14.01, 95% CI: -22.85~-5.17, P=0.002), postoperative length of hospital stay ( WMD=-0.69, 95% CI: -0.90~-0.49, P<0.001) were shorter than IA group. Conclusions:For patients who undergoing radical gastrectomy for gastric cancer, epidural analgesia could provide better pain control either pain at rest or on movement, although a rising incidence of hypotension was leaded, reduced pulmonary complications, nausea and vomiting were found, and promote the bowel function and shorten the duration of hospital stay.
