Epidural versus intravenous analgesia following radical gastrectomy for gastric cancer: A systematic review and Meta-analysis / 国际外科学杂志

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.