title: Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery.
abstract: The objective of this review was to systematically assess the effect of thoracic epidural analgesia (TEA) vs. systemic analgesia (SA) on the recovery of gastrointestinal (GI) function in patients following GI surgery. We performed a comprehensive literature search to identify randomized controlled trials of adult patients undergoing GI surgery, comparing the effect of two postoperative analgesia regimens. Patients postoperatively receiving local anesthesia-based TEA with or without opioids were compared to patients receiving opioid-based SA. The outcomes considered were times to GI function recovery, GI complications, and specific side effects. Twelve studies with 331 patients in the TEA group and 319 in the SA group were included. Compared to SA, TEA improved the GI recovery after GI procedures by shortening the time to first passage of flatus by 31.3 h, 95% confidence intervals (CIs): -33.2 to -29.4, P < 0.01; and shortening the time to first passage of stool by 24.1 h, 95% CIs: -27.2 to -20.9, P < 0.001. There was no difference between the groups in the incidence of anastomotic leakage and ileus. The occurrence of postoperative hypotension was relatively higher in the TEA group, risk ratio: 7.9, 95% CIs: 2.4 to 26.5, P = 0.001; other side effects (such as pruritus and vomiting) were similar in the two groups. There is evidence that TEA (compared to SA) improves the recovery of GI function after GI procedures without any increased risk of GI complications. To further confirm these effects, larger, better quality randomized controlled trials with standard outcome measurements are needed.
authors: Department of Anesthesia and Operation Center, Hainan Branch of PLA General Hospital, Sanya, China; Department of Anesthesia and Operation Center, PLA General Hospital, Beijing, China.
authors: W-Z
authors: WZ
authors: Shi
authors: Y-L
authors: YL
authors: Miao
authors: M Y
authors: MY
authors: Yakoob
authors: J-B
authors: JB
authors: Cao
authors: H
authors: H
authors: Zhang
authors: Y-G
authors: YG
authors: Jiang
authors: L-H
authors: LH
authors: Xu
authors: W-D
authors: WD
authors: Mi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D057868:Anastomotic Leak / Q000453:epidemiology; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005414:Flatulence; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology; D011537:Pruritus / Q000453:epidemiology / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function; D017792:Surgical Stapling; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D009294:Narcotics