HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis.

AbstractBACKGROUND/PURPOSE:
The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER.
METHODS:
We searched MEDLINE (1946-2012) and the Cochrane Library (inception-2012) for randomized controlled trials (RCT) and cohort studies comparing epidural analgesia to PCA for postoperative pain management in children following MIPER. We calculated weighted mean differences (WMD) for numeric pain scores and summarized secondary outcomes qualitatively.
RESULTS:
Of 699 studies, 3 RCTs and 3 retrospective cohorts met inclusion criteria. Compared to PCA, mean pain scores were modestly lower with epidural immediately (WMD -1.04, 95% CI -2.11 to 0.03, p=0.06), 12 hours (WMD -1.12; 95% CI -1.61 to -0.62, p<0.001), 24 hours (WMD -0.51, 95%CI -1.05 to 0.02, p=0.06), and 48 hours (WMD -0.85, 95% CI -1.62 to -0.07, p=0.03) after surgery. We found no statistically significant differences between secondary outcomes.
CONCLUSIONS:
Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.
AuthorsAndrea M Stroud, Darena D Tulanont, Thomasena E Coates, Philip P Goodney, Daniel P Croitoru
JournalJournal of pediatric surgery (J Pediatr Surg) Vol. 49 Issue 5 Pg. 798-806 (May 2014) ISSN: 1531-5037 [Electronic] United States
PMID24851774 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Topics
  • Analgesia, Epidural (adverse effects, economics)
  • Analgesia, Patient-Controlled (adverse effects, economics)
  • Child
  • Cost-Benefit Analysis
  • Funnel Chest (surgery)
  • Humans
  • Length of Stay
  • Minimally Invasive Surgical Procedures
  • Operative Time
  • Pain, Postoperative (prevention & control)
  • Research Design (standards)
  • Retrospective Studies

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: