Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis.
OBJECTIVE
The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER.


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.
The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. Electronic address: Andrea.M.Stroud@hitchcock.org.
Andrea M
AM
Stroud
The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH 03755, USA.
Darena D
DD
Tulanont
The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH 03755, USA.
Thomasena E
TE
Coates
Section of Vascular Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Philip P
PP
Goodney
Section of Pediatric Surgery, Department of Surgery, Geisel School of Medicine, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Daniel P
DP
Croitoru
D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control*; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies
Analgesia; Epidural; Minimally invasive pectus excavatum repair; Nuss; Pain control