title: Comparison of patient-controlled epidural analgesia and patient-controlled intravenous analgesia after spinal fusion surgery: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The objective of this meta-analysis was to compare the efficacy and safety of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) in postoperative analgesia of spinal fusion surgery.
  
  
  METHODS
  Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5) and ScienceDirect (1966-2015.5). Gray studies were identified from the references of the included literature. Randomized controlled trials (RCTs) involving PCEA and PCIA after spinal fusion were included. Two independent reviewers performed independent data abstraction. I(2) statistic was used to assess heterogeneity. Fixed or random effects model was used for meta-analysis.
  
  
  RESULTS
  Eight RCTs met the inclusion criteria. There was a better analgesic effect in patients with PCEA for postoperative VAS on the first day (P = 0.0005) and second day (P = 0.006). The patients with PCEA had a higher incidence of pruritus (P = 0.02) and paresthesia (P = 0.03) after surgery than those with PCIA. There was no statistically significant difference in postoperative VAS on the third day (P = 0.15), nausea (P = 0.74) or emesis (P = 0.37) between the two groups.
  
  
  CONCLUSIONS
  After spinal fusion, the patients with PCEA have similar analgesic efficacy during the three postoperative days and a higher incidence of pruritus and paresthesia than those with PCIA. Due to the limited quality and data of the evidence currently available, more high-quality randomized controlled trials are required.
authors.affiliation: Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China. tianpeng007@foxmail.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Tian
authors.affiliation: Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China. sanjinfu@gmail.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Fu
authors.affiliation: Department of Orthopedics, General Hospital of Tianjin Medical University, No.154, Anshan Road, Tianjin, 300052, People's Republic of China. hansontijmu@gmail.com.
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China. orthodoc969@gmail.com.
authors.forename: Xin-long
authors.initials: XL
authors.lastname: Ma
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D006801:Humans; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends