Evaluating analgesia strategies in patients who have undergone oesophagectomy—a systematic review and network meta-analysis of randomised clinical trials
Male
Pain, Postoperative
Network Meta-Analysis
Middle Aged
Length of Stay
Esophagectomy
Analgesics, Opioid
Analgesia, Epidural
03 medical and health sciences
0302 clinical medicine
Humans
Pain Management
Female
Analgesia
Randomized Controlled Trials as Topic
Pain Measurement
Aged
DOI:
10.1093/dote/doad074
Publication Date:
2024-01-15T08:14:09Z
AUTHORS (8)
ABSTRACT
Summary
Optimal pain control following esophagectomy remains a topic of contention. The aim was to perform a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating the analgesia strategies post-esophagectomy. A NMA was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using Shiny and R. Fourteen RCTs which included 565 patients and assessed nine analgesia techniques were included. Relative to systemic opioids, thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01–0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: −36.2, 95% CI: −61.44–10.96) (n = 569, 15 RCTs) and dynamic (MD: −42.90, 95% CI: −68.42–17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: −13.05, 95% CI: −22.74–3.36) and dynamic (MD: −18.08, 95% CI: −31.70–4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: −33.20, 95% CI: −60.57–5.83) and 48 hours (MD: −42.66, 95% CI: −59.45–25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: −5.00, 95% CI: −6.82–3.18) and time to extubation (MD: −4.40, 95% CI: −5.91–2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91–18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87–26.87). TEA provides optimal pain control and improved post-operative respiratory function in patients post-esophagectomy, reducing ICU stays, one of the benchmarks of improved post-operative recovery. IPA demonstrates promising results for potential implementation in the future following esophagectomy.
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