title: A comparison of the postoperative analgesic efficacy between epidural and intravenous analgesia in major spine surgery: a meta-analysis.
abstract: Postoperative analgesia remains a challenge for orthopedic surgeons. The aim of this meta-analysis is to compare the efficacy of epidural analgesia (EA) and intravenous patient-controlled analgesia (IV-PCA) following major spine surgery. We searched electronic databases, including the PubMed, EMBASE, Ovid and Cochrane databases, for randomized controlled trials (RCTs) published before June 2016. The quality of the included trials was assessed using the Cochrane risk-of-bias tool. Random effects models were used to estimate the standardized mean differences (SMDs) and relative risks (RRs), with the corresponding 95% confidence intervals (CI). Subgroup analyses stratified by the type of epidural-infused medication and epidural delivery were also performed. A total of 17 trials matched the inclusion criteria and were chosen for the following meta-analysis. Overall, EA provided significantly superior analgesia, higher patient satisfaction and decreased overall opioid consumption compared with IV-PCA following major spine surgery. Additionally, no differences were found in the side effects associated with these two methods of analgesia. Egger's and Begg's tests showed no significant publication bias. We suggest that EA is superior to IV-PCA for pain management after major spine surgery. More large-scale, high-quality trials are needed to verify these findings.
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Yichen
authors.initials: Y
authors.lastname: Meng
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Heng
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Jianquan
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Ce
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Gao
authors.affiliation: Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Xuhui
authors.initials: X
authors.lastname: Zhou
keywords: adolescent idiopathic scoliosis; epidural analgesia; intravenous application; lumbar fusion; perioperative pain