A systematic review and meta-analysis of thoracic epidural analgesia versus other analgesic techniques in patients post-oesophagectomy.

IF 2 3区 医学 Q2 ANESTHESIOLOGY Perioperative Medicine Pub Date : 2024-07-23 DOI:10.1186/s13741-024-00437-0
Duncan Macrosson, Adam Beebeejaun, Peter M Odor
{"title":"A systematic review and meta-analysis of thoracic epidural analgesia versus other analgesic techniques in patients post-oesophagectomy.","authors":"Duncan Macrosson, Adam Beebeejaun, Peter M Odor","doi":"10.1186/s13741-024-00437-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Oesophageal cancer surgery represents a high perioperative risk of complications to patients, such as postoperative pulmonary complications (PPCs). Postoperative analgesia may influence these risks, but the most favourable analgesic technique is debated. This review aims to provide an updated evaluation of whether thoracic epidural analgesia (TEA) has benefits compared to other analgesic techniques in patients undergoing oesophagectomy surgery. Our hypothesis is that TEA reduces pain scores and PPCs compared to intravenous opioid analgesia in patients post-oesophagectomy.</p><p><strong>Methods: </strong>Electronic databases PubMed, Excerpta Medica Database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomised trials of analgesic interventions in patients undergoing oesophagectomy surgery. Only trials including thoracic epidural analgesia compared with other analgesic techniques were included. The primary outcome was a composite of respiratory infection, atelectasis and respiratory failure (PPCs), with pain scores at rest and on movement as secondary outcomes. Data was pooled using random effect models and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Data from a total of 741 patients in 10 randomised controlled trials (RCTs) from 1993 to 2023 were included. Nine trials were open surgery, and one trial was laparoscopic. Relative to intravenous opioids, TEA significantly reduced a composite of PPCs (risk ratio (RR) 3.88; 95% confidence interval (CI) 1.98-7.61; n = 222; 3 RCTs) and pain scores (0-100-mm visual analogue scale or VAS) at rest at 24 h (MD 9.02; 95% CI 5.88-12.17; n = 685; 10 RCTs) and 48 h (MD 8.64; 95% CI 5.91-11.37; n = 685; 10 RCTs) and pain scores on movement at 24 h (MD 14.96; 95% CI 5.46-24.46; n = 275; 4 RCTs) and 48 h (MD 16.60; 95% CI 8.72-24.47; n = 275; 4 RCTs).</p><p><strong>Conclusions: </strong>Recent trials of analgesic technique in oesophagectomy surgery are restricted by small sample size and variation of outcome measurement. Despite these limitations, current evidence indicates that thoracic epidural analgesia reduces the risk of PPCs and severe pain, compared to intravenous opioids in patients following oesophageal cancer surgery. Future research should include minimally invasive surgery, non-epidural regional techniques and record morbidity, using core outcome measures with standardised endpoints.</p><p><strong>Trial registration: </strong>Prospectively registered on PROSPERO (CRD42023484720).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"80"},"PeriodicalIF":2.0000,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11267804/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perioperative Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13741-024-00437-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Oesophageal cancer surgery represents a high perioperative risk of complications to patients, such as postoperative pulmonary complications (PPCs). Postoperative analgesia may influence these risks, but the most favourable analgesic technique is debated. This review aims to provide an updated evaluation of whether thoracic epidural analgesia (TEA) has benefits compared to other analgesic techniques in patients undergoing oesophagectomy surgery. Our hypothesis is that TEA reduces pain scores and PPCs compared to intravenous opioid analgesia in patients post-oesophagectomy.

Methods: Electronic databases PubMed, Excerpta Medica Database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomised trials of analgesic interventions in patients undergoing oesophagectomy surgery. Only trials including thoracic epidural analgesia compared with other analgesic techniques were included. The primary outcome was a composite of respiratory infection, atelectasis and respiratory failure (PPCs), with pain scores at rest and on movement as secondary outcomes. Data was pooled using random effect models and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs).

Results: Data from a total of 741 patients in 10 randomised controlled trials (RCTs) from 1993 to 2023 were included. Nine trials were open surgery, and one trial was laparoscopic. Relative to intravenous opioids, TEA significantly reduced a composite of PPCs (risk ratio (RR) 3.88; 95% confidence interval (CI) 1.98-7.61; n = 222; 3 RCTs) and pain scores (0-100-mm visual analogue scale or VAS) at rest at 24 h (MD 9.02; 95% CI 5.88-12.17; n = 685; 10 RCTs) and 48 h (MD 8.64; 95% CI 5.91-11.37; n = 685; 10 RCTs) and pain scores on movement at 24 h (MD 14.96; 95% CI 5.46-24.46; n = 275; 4 RCTs) and 48 h (MD 16.60; 95% CI 8.72-24.47; n = 275; 4 RCTs).

Conclusions: Recent trials of analgesic technique in oesophagectomy surgery are restricted by small sample size and variation of outcome measurement. Despite these limitations, current evidence indicates that thoracic epidural analgesia reduces the risk of PPCs and severe pain, compared to intravenous opioids in patients following oesophageal cancer surgery. Future research should include minimally invasive surgery, non-epidural regional techniques and record morbidity, using core outcome measures with standardised endpoints.

Trial registration: Prospectively registered on PROSPERO (CRD42023484720).

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
胸腔硬膜外镇痛与其他镇痛技术在食管切除术后患者中的应用的系统回顾和荟萃分析。
背景:食道癌手术患者围手术期并发症风险很高,如术后肺部并发症(PPCs)。术后镇痛可能会影响这些风险,但最有利的镇痛技术还存在争议。本综述旨在对胸腔硬膜外镇痛(TEA)与其他镇痛技术相比是否对食道切除手术患者有益进行最新评估。我们的假设是,与静脉注射阿片类药物镇痛相比,TEA可降低食管切除术后患者的疼痛评分和PPCs:在 PubMed、Excerpta Medica Database (EMBASE) 和 Cochrane Central Register of Controlled Trials (CENTRAL) 等电子数据库中搜索了针对食管切除手术患者的镇痛干预随机试验。其中仅包括胸腔硬膜外镇痛与其他镇痛技术的对比试验。主要结果是呼吸道感染、肺不张和呼吸衰竭(PPCs)的综合结果,次要结果是休息时和运动时的疼痛评分。采用随机效应模型对数据进行汇总,并以相对风险(RR)或平均差异(MD)及 95% 置信区间(CI)的形式进行报告:共纳入了1993年至2023年期间10项随机对照试验(RCT)中741名患者的数据。其中九项为开放手术,一项为腹腔镜手术。与静脉注射阿片类药物相比,TEA 能显著降低 PPCs 的综合评分(风险比 (RR) 3.88;95% 置信区间 (CI)1.98-7.61;n = 222;3 项 RCTs)和 24 小时休息时的疼痛评分(0-100 毫米视觉模拟量表或 VAS)(MD 9.02;95% CI 5.24小时(MD 14.96;95% CI 5.46-24.46;n = 275;4项研究)和48小时(MD 16.60;95% CI 8.72-24.47;n = 275;4项研究)运动时的疼痛评分(0-100毫米视觉模拟量表或VAS):近期关于食道切除手术镇痛技术的试验受到样本量小和结果测量差异的限制。尽管存在这些局限性,但目前的证据表明,与静脉注射阿片类药物相比,胸膜硬膜外镇痛可降低食道癌术后患者发生PPCs和剧烈疼痛的风险。未来的研究应包括微创手术、非硬膜外区域技术和记录发病率,使用标准化终点的核心结果测量:已在 PROSPERO(CRD42023484720)上进行了前瞻性注册。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
3.80%
发文量
55
审稿时长
10 weeks
期刊最新文献
Changes of perioperative cognitive function and its effect on quality of life in laryngeal cancer. National Institute of Academic Anaesthesia (NIAA) research grants: analysis of awardee characteristics and preliminary grant outputs. Assessment of perioperative anxiety levels at three time-points during hospital stay in patients undergoing elective surgery. Exploring the predictive value of carotid Doppler ultrasound and clinical features for spinal anesthesia-induced hypotension: a prospective observational study. PACU discharge: equally safe and more cost-effective than floor admission for uncomplicated laparoscopic appendectomy.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1