title: Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies.
abstract: Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06-2.08) without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program.
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy.
authors.forename: Giuseppe
authors.identifier: 0000-0002-3378-4548
authors.initials: G
authors.lastname: Borzellino
authors.affiliation: Yeovil District Hospital and University of Bath, District Hospital NHS Foundation Trust, Taunton, UK.
authors.forename: Nader Kamal
authors.initials: NK
authors.lastname: Francis
authors.affiliation: Clinique Chirurgicale Val d'Or, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chapuis
authors.affiliation: Clinical Research Platform, URC-CRC, Saint Antoine Hospital, APHP, Paris, France.
authors.forename: Evguenia
authors.identifier: 0000-0003-0230-3796
authors.initials: E
authors.lastname: Krastinova
authors.affiliation: Clinical Research Platform, URC-CRC, Saint Antoine Hospital, APHP, Paris, France.
authors.forename: Valérie
authors.identifier: 0000-0003-3495-7225
authors.initials: V
authors.lastname: Dyevre
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy.
authors.forename: Michele
authors.identifier: 0000-0002-4984-6758
authors.initials: M
authors.lastname: Genna