INTRAVENOUS VERSUS EPIDURAL ROUTES OF PATIENT-CONTROLLED ANALGESIA IN ABDOMINAL SURGERY: SYSTEMATIC REVIEW WITH META-ANALYSIS
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Date
2022
Authors
Viderman, Dmitriy
Tapinova, Karina
Nabidollayeva, Fatima
Tankacheev, Ramil
Abdildin, Yerkin G.
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Clinical Medicine
Abstract
Objective: To compare the intravenous and epidural routes of patient-controlled anesthesia
in abdominal surgery. Methods: We searched for randomized clinical trials that compared the
intravenous and epidural modes of patient-controlled anesthesia in intra-abdominal surgery in adults.
Data analysis was performed in RevMan 5.4. Heterogeneity was measured using I2
statistic. Risk of
bias was assessed using the Jadad/Oxford quality scoring system. Results: Seven studies reporting
529 patients were included into the meta-analysis. For pain at rest, the mean difference with 95%
confidence interval (CI) was −0.00 [−0.79, 0.78], p-value 0.99, while for pain on coughing, it was
0.43 [−0.02, 0.88], p-value 0.06, indicating that patient-controlled epidural analgesia (PCEA) was
superior. For the sedation score, the mean difference with 95% CI was 0.26 [−0.37, 0.89], p-value 0.42,
slightly favoring PCEA. For the length of hospital stay, the mean difference with 95% CI was 1.13
[0.29, 1.98], p-value 0.009, favoring PCEA. For postoperative complications, the risk ratio with 95% CI
was 0.8 [0.62, 1.03], p-value 0.08, slightly favoring patient-controlled intravenous analgesia (PCIVA).
A significant effect was observed for hypotension, favoring PCIVA. Conclusions: Patient-controlled
intravenous analgesia compared with patient-controlled epidural analgesia was associated with
fewer episodes of hypotension. PCEA, on other hand, was associated with a shorter length of hospital
stay. Pain control and other side effects did not differ significantly. Only three studies out of seven
had an acceptable methodological quality. Thus, these conclusions should be taken with caution
Description
Keywords
Type of access: Open Access, patient-controlled analgesia, epidural analgesia, intravenous analgesia, pain control, abdominal surgery, postoperative pain
Citation
Viderman, D., Tapinova, K., Nabidollayeva, F., Tankacheev, R., & Abdildin, Y. G. (2022). Intravenous versus Epidural Routes of Patient-Controlled Analgesia in Abdominal Surgery: Systematic Review with Meta-Analysis. Journal of Clinical Medicine, 11(9), 2579. https://doi.org/10.3390/jcm11092579