Abstract ID: A25
Abstract Title: Analgesic Efficacy of Extrapleural Catheters versus Thoracic Epidural Analgesia for Postoperative Pain Control after Thoracic Surgery: A Systematic Review/Meta-analysis
Authors: Bolka J1, Hurley R2, Hanna M3, Wu C4
The Johns Hopkins University Baltimore MD USA1, The Johns Hopkins University Baltimore MD USA2, The Johns Hopkins University Baltimore MD USA3, The Johns Hopkins University Baltimore MD USA4
Poster Type: Poster
ABSTRACT BODY
Introduction:
Extrapleural (paravertebral) analgesia is an accepted technique for the management of postoperative analgesia; however, its efficacy compared to thoracic epidural analgesia, a standard for postoperative analgesia after thoracotomy, is unclear. Because of some of the inconsistencies in the available data, we performed a systematic review and meta-analysis of randomized trials to determine the analgesic efficacy of extrapleural analgesia versus thoracic epidural analgesia after thoracic surgery.
Materials and Methods:
We searched the National Library of Medicine's PubMed database for the time period 1966 to October, 2005 for textwords related to extrapleural, paravertebral, and epidural analgesia. To be included in this meta-analysis, the use of extrapleural and paravertebral analgesia had to be compared to thoracic epidural analgesia following thoracic surgery. Other inclusion criteria included trials that were randomized, evaluated only adult patients, and where pain scores were available in a format which could be analyzed in a meta-analysis. Data was extracted from the manuscript including figures as necessary. A random effects model was used. No minimum sample sizes were used. All statistical analyses (i.e., determination of the pooled estimate, test for heterogeneity) were performed with RevMan 4.2.7 (The Cochrane Collaboration, 2004)
Results:
After limiting this search to the English language and human subjects, our search resulted in 63 abstracts, the full article of each which was then reviewed. A total of 6 trials (152 subjects received extrapleural or paravertebral analgesia; 149 subjects received epidural analgesia) met all inclusion criteria. Extrapleural or paravertebral catheters provided equivalent analgesia compared to thoracic epidural analgesia at 8-12 hours (weighted mean difference [WMD] = -0.35; 95% confidence interval [CI] = -1.11, 0.40) and at 20-24 hours (WMD = -0.05; 95% CI = -0.71, 0.61).
Discussion:
Analyzing data from available randomized controlled trials, we found that extrapleural-paravertebral analgesia provided similar levels of postoperative analgesia compared to thoracic epidural analgesia; however, a definitive conclusion regarding the analgesic efficacy of the 2 techniques cannot be made due to the presence of study design-related issues and the limitation of the meta-analytic technique in this case.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A25