Abstract | BACKGROUND/PURPOSE: 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.
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Authors | Andrea M Stroud, Darena D Tulanont, Thomasena E Coates, Philip P Goodney, Daniel P Croitoru |
Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 49
Issue 5
Pg. 798-806
(May 2014)
ISSN: 1531-5037 [Electronic] United States |
PMID | 24851774
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Copyright | Copyright © 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
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