Article ; Online: Evaluating analgesia strategies in patients who have undergone oesophagectomy-a systematic review and network meta-analysis of randomised clinical trials.
2024 Volume 37, Issue 5
Abstract: 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 ... ...
| Abstract | 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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| MeSH term(s) | Humans ; Esophagectomy/adverse effects ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Pain, Postoperative/etiology ; Randomized Controlled Trials as Topic ; Network Meta-Analysis ; Analgesics, Opioid/therapeutic use ; Analgesia, Epidural/methods ; Female ; Male ; Pain Measurement ; Middle Aged ; Aged ; Pain Management/methods ; Analgesia/methods ; Length of Stay/statistics & numerical data |
| Chemical Substances | Analgesics, Opioid |
| Language | English |
| Publishing date | 2024-01-11 |
| Publishing country | United States |
| Document type | Systematic Review ; Journal Article ; Meta-Analysis |
| ZDB-ID | 639470-x |
| ISSN | 1442-2050 ; 1120-8694 |
| ISSN (online) | 1442-2050 |
| ISSN | 1120-8694 |
| DOI | 10.1093/dote/doad074 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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