Effects of preemptive epidural analgesia on post-thoracotomy pain.
OBJECTIVE
The purpose of this study was to determine whether preemptive thoracic epidural analgesia (TEA) initiated before surgical incision would reduce the severity of acute post-thoracotomy pain and the incidence of chronic post-thoracotomy pain.


METHODS
Meta-analysis of randomized controlled trials (RCTs).


METHODS
MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE were searched from 1966 to December 2004 for prospective RCTs published in all languages using the following MeSH terms: post-thoracotomy pain, epidural analgesia, chronic pain, and preemptive analgesia.


METHODS
All RCTs that compared thoracic epidural analgesia initiated before surgical incision (preemptive group) versus thoracic epidural analgesia initiated after completion of surgery (control group) in adult patients undergoing unilateral thoracotomy.


RESULTS
Three authors reviewed all citations and simultaneously extracted data on sample size, patient characteristics, surgical and analgesic interventions, methods of pain assessment, and pain scores at 24 hours, 48 hours, and 6 months postoperatively. Six studies were included with a total of 458 patients. Pooled analyses indicated that preemptive TEA was associated with a statistically significant reduction in the severity of acute pain on coughing at 24 and 48 hours (weighted mean difference -1.17 [95% confidence interval (CI) -1.50 to -0.83] and -1.08 [95% CI -1.17 to -0.99]), respectively. Acute pain was a good predictor of chronic pain. However, there was no statistically significant difference in the overall incidence of chronic pain at 6 months between the preemptive TEA group (39.6%) and the control group (48.6%).


CONCLUSIONS
Preemptive TEA appeared to reduce the severity of acute pain but had no effect on the incidence of chronic pain.
Bong
Choon Looi
CL
Department of Paediatric Anesthesia, KK Women and Childrens' Hospital, Singapore. cchia@doctors.org.uk
Samuel
Miny
M
Ng
Ju Mei
JM
Ip-Yam
Chris
C
D015360:Analgesia, Epidural; D002908:Chronic Disease; D006801:Humans; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013908:Thoracotomy