Abstract ID: A12
Abstract Title: Efficacy of Postoperative Epidural Analgesia versus Intravenous Patient-controlled Analgesia with Opioids: a Meta-Analysis
Poster Type: Either
ABSTRACT BODY
Introduction:
Although epidural analgesia appears to provide better postoperative pain control than systemic opioids in available systematic reviews, the analgesic efficacy of epidural analgesia compared to that of intravenous patient-controlled analgesia (IV PCA) per se is unclear.
Materials and Methods:
Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966 - August 4, 2004) for terms related to postoperative epidural analgesia and IV PCA. Inclusion criteria were a comparison of epidural therapy versus IV PCA for postoperative analgesia of ¡Ý 24 hours in duration, measurement of pain using a visual analog scale (VAS) or numeric rating scale (NRS), randomization of patients, and adult subjects. Each article from the final search was reviewed and data extracted from tables, text, or extrapolated from figures as needed. Weighted mean pain scores, weighted mean differences in pain score, and incidences of complications between the groups were determined.
Results:
The search resulted in 299 abstracts from which the original articles were obtained and data abstracted with a total of 50 articles ultimately analyzed. Epidural analgesia overall provided superior postoperative analgesia compared to IV PCA (p < 0.001). When analyzed by postoperative day, epidural analgesia was superior to IV PCA on each postoperative day (p < 0.001). Subgroup analysis was performed for surgical site, type of analgesic regimen and type of pain assessed. For all types of surgery and pain assessments, all forms of epidural analgesia (i.e., both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared to IV PCA (p < 0.001). Compared to IV PCA, the epidural group had a lower incidence of nausea/vomiting and sedation but a higher incidence of pruritus, urinary retention and motor block.
Discussion:
Almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to IV PCA.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A12