Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery.
BACKGROUND
Epidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate.


METHODS
A systematic review of randomized controlled trials comparing postoperative EA and parenteral opioid analgesia after colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of length of hospital stay, pain intensity, duration of postoperative ileus, incidence of postoperative complications and side-effects.


RESULTS
Sixteen trials published between 1987 and 2005 were included. EA significantly reduced pain scores and duration of ileus (weighted mean difference - 1.55 (95 per cent confidence interval (c.i.) - 2.27 to - 0.84) days). On the other hand, it was associated with a significant increase in the incidence of pruritus (odds ratio (OR) 4.8 (95 per cent c.i. 1.3 to 17.0)), urinary retention (OR 4.3 (1.2 to 15.9)) and arterial hypotension (OR 13.5 (4.0 to 57.7)). EA did not influence duration of hospital stay.


CONCLUSIONS
Despite improved analgesia and a decrease in ileus, EA has some adverse effects and does not shorten the duration of hospital stay after colorectal surgery.
Marret
E
E
Department of Anaesthetics and Intensive Care, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris, University of Pierre and Marie Curie, Paris, France. emmanuel.marret@tnn.aphp.fr
Remy
C
C
Bonnet
F
F
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D006801:Humans; D045823:Ileus / Q000517:prevention & control; D007263:Infusions, Parenteral; D007902:Length of Stay / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
D000701:Analgesics, Opioid