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Cochrane Database of Systematic Reviews

使用硬膜外局部麻醉與鴨片類藥物麻醉方案對於腹部手術後腸胃道麻痹、嘔吐及疼痛之比較

Información

DOI:
https://doi.org/10.1002/14651858.CD001893.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 15 julio 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Anestesia

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Joanne Guay

    Correspondencia a: Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Canada

    [email protected]

    [email protected]

  • Mina Nishimori

    Department of Anesthesiology, Seibo International Catholic Hospital, Tokyo, Japan

  • Sandra Kopp

    Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, USA

Contributions of authors

Conceiving of the review: Joanne Guay (JG) and Sandra Kopp (SK).

Co‐ordinating the review: JG.

Screening search results: JG.

Screening retrieved papers against inclusion criteria: JG and Mina Nishimori (MN).

Appraising the quality of papers: JG and MN.

Abstracting data from papers: JG and MN.

Managing data for the review: JG.

Entering data into Review Manager: JG.

Analysing RevMan statistical data: JG.

Performing other statistical analysis not using RevMan: JG.

Interpreting data: JG, MN and SK.

Making statistical inferences: JG.

Writing the review: JG, MN and SK.

Securing funding for the review: departmental resources only.

Performing previous work that was the foundation of the present study: JG and SK.

Serving as guarantor for the review: JG.

Taking responsibility for reading and checking the review before submission: JG, MN and SK.

Sources of support

Internal sources

  • University of Quebec en Abitibi Temiscamingue (UQAT), Canada.

    UQAT provided the articles (in part)

  • University of Montreal, Canada.

    University of Montreal provided access to databases and some of the articles

External sources

  • No sources of support supplied

Declarations of interest

Joanne Guay: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies. I do not hold stock other than mutual funds. I am the editor of a multi‐author textbook on anaesthesia (including notions on general and regional anaesthesia). I receive fees for a course on airway management at University of Quebec, in Abitibi‐Temiscamingue.

Mina Nishimori: no conflicts of interest.

Sandra Kopp: no conflicts of interest.

Acknowledgements

The review authors wish to thank the University of Quebec in Abitibi Temiscamingue, the University of Sherbrooke and the University of Montreal for providing access to electronic databases and medical journals. We also wish to thank Dat Nhut Nguyen, who participated in data extraction and gradation of the level of evidence but preferred to withdraw from the review on May 28, 2015, because of lack of academic time. We also thank Jia Jiang for the translation of Chinese studies (Cai 2007; Han 2005; Hu 2006; Liu 2005; Wang 2010; Zeng 2003). We extend our thanks to Honario T Benzon (Benzon 1994), Joergen B. Dahl (Bisgaard 1990), Joel Katz (Boylan 1998), Franco Carli (Carli 1997; Lugli 2008; Lugli 2010), Enrique Calderón (Calderon 2004), Joergen B Dahl (Dahl 1992), Christian Jayr (Jayr 1998; Motamed 1998), Rainer Kentner (Kentner 1996), Leonidas Grigorakos (Limberi 2003), Luc Massicotte (Mondor 2010), Michael G. Rockemann (Rockemann 1997), Henrik Kehlet (Schulze 1988; Schulze 1992), Roman Schumann (Schumann 2003), Charles Gibson (Steinberg 2002) and S.L. Tsui (Tsui 1997), who provided additional information on their studies or took the time to reply when data were no longer available, and Nesrine El‐Refai (El‐Refai 2003), who graciously provided a copy of his article.

We also wish to thank Mark Neuman (content editor), Cathal Walsh (statistical editor), Paul S. Myles, Fahad Javaid Siddiqui, James Paul (peer reviewers), Shunjie Chua (consumer referee) for their help and editorial advice during the preparation of this updated systematic review.

Version history

Published

Title

Stage

Authors

Version

2016 Jul 15

Epidural local anaesthetics versus opioid‐based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

Review

Joanne Guay, Mina Nishimori, Sandra Kopp

https://doi.org/10.1002/14651858.CD001893.pub2

2001 Jan 22

Epidural local anaesthetics versus opioid‐based analgesic regimens for postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery

Review

Henrik Jørgensen, Jørn Wetterslev, Steen Møiniche, Jørgen B Dahl

https://doi.org/10.1002/14651858.CD001893

Differences between protocol and review

This is an update. We made the following modifications to the previous version.

Study selection, types of participants: We also included laparoscopic abdominal surgery.

Outcomes:

We limited the total number to seven.

We deleted the following.

Paracetamol absorption test as a measure of gastric emptying.

Passage of barium sulphate through the large intestine.

Nausea.

Surgical complications.

We added the following.

Gastrointestinal anastomotic leak.

Length of stay in hospital.

Cost.

Data collection and analysis

Quality of study: We assessed study quality with the new Cochrane tool as presenting low risk, unclear risk or high risk of bias for randomization, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, selective reporting and other bias.

We presented results for dichotomous outcomes as risk ratios. We provided continuous data measured on different scales or entered as P values as standardized mean differences. When this happened, we provided clinical equivalence. We assessed small‐study effects with Eger's regression intercept and publication bias with Duval and Tweedie's trim and fill analysis. We calculated the number needed for an additional beneficial or harmful outcome when appropriate. We calculated optimal information size when appropriate. We added meta‐regressions for exploration of heterogeneity. We assessed the quality of the body of evidence according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) recommendations. We added a 'Summary of findings' table.

Notes

August 2015

To include maximal data with no assumption, we entered data expressed as median and range via another software, using the exact P value and the number of participants included in each group (a function not provided by RevMan). We then transferred data to RevMan as standardized mean difference (SMD) and standard error (SE). For this reason, results provided in the text (exact calculations from www.Meta‐Analysis.com) may sometimes differ by a few decimal places from those noted in the Figures (automatically recalculated in RevMan from SMD and SE entered). Conclusions (effects found or not found) were never affected by these small differences.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Flow diagram. Study selection from the 2014 search. We reran the search in February 2016, and added 16 potential new studies of interest to the list of ‘Studies awaiting classification'. These studies will be incorporated into the formal review findings during the next review update. We also found one ongoing trial.
Figuras y tablas -
Figure 1

Flow diagram. Study selection from the 2014 search. We reran the search in February 2016, and added 16 potential new studies of interest to the list of ‘Studies awaiting classification'. These studies will be incorporated into the formal review findings during the next review update. We also found one ongoing trial.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Meta‐regression of effects of the concentration of local anaesthetic used (mg/mL) after surgery on the standardized mean difference for return of gastrointestinal transit as measured by the time required to obtain first flatus. P value = 0.0008.
Figuras y tablas -
Figure 4

Meta‐regression of effects of the concentration of local anaesthetic used (mg/mL) after surgery on the standardized mean difference for return of gastrointestinal transit as measured by the time required to obtain first flatus. P value = 0.0008.

Meta‐regression of the effects of mean age of participants included in the study on VAS scores at rest at 48 hours (P value = 0.0002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.
Figuras y tablas -
Figure 5

Meta‐regression of the effects of mean age of participants included in the study on VAS scores at rest at 48 hours (P value = 0.0002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.

Meta‐regression of the effects of mean age of participants included in the study on VAS scores on movement at 48 hours (P value = 0.002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.
Figuras y tablas -
Figure 6

Meta‐regression of the effects of mean age of participants included in the study on VAS scores on movement at 48 hours (P value = 0.002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 1 Time to first flatus subgrouped by type of surgery.
Figuras y tablas -
Analysis 1.1

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 1 Time to first flatus subgrouped by type of surgery.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 2 Time to first faeces subgrouped according to duration of local anaesthetic administration.
Figuras y tablas -
Analysis 1.2

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 2 Time to first faeces subgrouped according to duration of local anaesthetic administration.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 3 Pain scores at rest at 6 to 8 hours after surgery subgrouped by type of surgery.
Figuras y tablas -
Analysis 1.3

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 3 Pain scores at rest at 6 to 8 hours after surgery subgrouped by type of surgery.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 4 Pain scores on movement at 6 to 8 hours after surgery subgrouped by type of opioid in the control group.
Figuras y tablas -
Analysis 1.4

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 4 Pain scores on movement at 6 to 8 hours after surgery subgrouped by type of opioid in the control group.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 5 Pain scores at rest at 24 hours subgrouped by type of opioid in the epidural.
Figuras y tablas -
Analysis 1.5

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 5 Pain scores at rest at 24 hours subgrouped by type of opioid in the epidural.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 6 Pain scores at rest at 24 hours subgrouped by opioid in the control group.
Figuras y tablas -
Analysis 1.6

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 6 Pain scores at rest at 24 hours subgrouped by opioid in the control group.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 7 Pain scores on movement at 24 hours subgrouped by type of surgery.
Figuras y tablas -
Analysis 1.7

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 7 Pain scores on movement at 24 hours subgrouped by type of surgery.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 8 Pain scores on movement at 24 hours subgrouped by type of opioid in the epidural.
Figuras y tablas -
Analysis 1.8

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 8 Pain scores on movement at 24 hours subgrouped by type of opioid in the epidural.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 9 Pain scores on movement at 24 hours subgrouped by type of opioids in the control group.
Figuras y tablas -
Analysis 1.9

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 9 Pain scores on movement at 24 hours subgrouped by type of opioids in the control group.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 10 Pain scores at rest at 48 hours subgrouped by type of solution used.
Figuras y tablas -
Analysis 1.10

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 10 Pain scores at rest at 48 hours subgrouped by type of solution used.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 11 Pain scores on movement at 48 hours subgrouped by type of solution in the epidural.
Figuras y tablas -
Analysis 1.11

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 11 Pain scores on movement at 48 hours subgrouped by type of solution in the epidural.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 12 Pain scores at rest at 72 hours subgrouped by type of solution used.
Figuras y tablas -
Analysis 1.12

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 12 Pain scores at rest at 72 hours subgrouped by type of solution used.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 13 Pain scores on movement at 72 hours subgrouped by type of solution used.
Figuras y tablas -
Analysis 1.13

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 13 Pain scores on movement at 72 hours subgrouped by type of solution used.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 14 Vomiting.
Figuras y tablas -
Analysis 1.14

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 14 Vomiting.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 15 Gastrointestinal tract anastomotic leak.
Figuras y tablas -
Analysis 1.15

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 15 Gastrointestinal tract anastomotic leak.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 16 Length of stay in hospital subgrouped by type of surgery.
Figuras y tablas -
Analysis 1.16

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 16 Length of stay in hospital subgrouped by type of surgery.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 17 Length of stay in hospital subgrouped by surgical site for open surgery only.
Figuras y tablas -
Analysis 1.17

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 17 Length of stay in hospital subgrouped by surgical site for open surgery only.

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 18 Costs.
Figuras y tablas -
Analysis 1.18

Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 18 Costs.

Summary of findings for the main comparison. Epidural local anaesthetic compared with opioid‐based regimen for adults

Epidural local anaesthetic compared with opioid‐based regimen for adults

Patient or population: adults
Settings: Trials were performed in Australia (n = 4); Canada (n = 19); China (n = 6); Czech Republic (n = 1); Denmark (n = 8); Egypt (n = 3); Finland (n = 4); France (n = 5); Germany (n = 10); Greece (n = 2); India (n = 3); Israel (n = 2); Italy (n = 10); Japan (n = 1); Korea (n = 1); Lithuania (n = 1); Romania (n = 2); Russia (n = 1); Serbia (n = 1); Spain (n = 1); Sweden (n = 6); Switzerland (n = 2); The Netherlands (n = 1); Turkey (n = 8); United Kingdom (n = 6); United States of America (n = 17); and Uruguay (n = 1)
Intervention: epidural local anaesthetic
Comparison: opioid‐based regimen

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Opioid‐based regimen

Epidural local anaesthetic

Time required to observe first flatus

Mean time required to observe first flatus in the intervention groups was
1.28 standard deviations lower
(1.71 to 0.86 lower)

1138
(22 studies)

⊕⊕⊕⊕
higha,b,c,d,e,f,g,h

Effect size was proportionate to the
concentration of
local anaesthetic
used
Pooled reduction is equivalent to 17.5
hours

Time required to observe first faeces

Mean time required to observe first faeces in the intervention groups was
0.67 standard deviations lower
(0.86 to 0.47 lower)

1559
(28 studies)

⊕⊕⊝⊝
lowc,d,e,g,i,j,k,l

Pooled reduction is
equivalent to 22 hours

VAS scores on movement at 24 hours

Mean VAS scores on movement at 24 hours in the intervention groups was
0.85 standard deviations lower
(1.04 to 0.67 lower)

2731
(35 studies)

⊕⊕⊕⊝
moderatea,b,c,d,e,f,g,l

Pooled reduction
is equivalent to 2.5 on a scale from 0 to 10

Vomiting during first 24 hours

Study population

RR 0.84
(0.57 to 1.23)

1154
(22 studies)

⊕⊕⊝⊝
lowc,e,g,i,k,l,m,n

170 per 1000

143 per 1000
(97 to 210)

Low

50 per 1000

42 per 1000
(28 to 62)

High

250 per 1000

210 per 1000
(142 to 308)

Anastomotic leak

Study population

RR 0.74
(0.41 to 1.32)

848
(17 studies)

⊕⊕⊝⊝
lowc,e,g,i,k,l,m,n

53 per 1000

39 per 1000
(22 to 70)

Low

30 per 1000

22 per 1000
(12 to 40)

High

100 per 1000

74 per 1000
(41 to 132)

Length of hospital stay

Mean length of hospital stay in the intervention groups was
0.20 standard deviations lower
(0.35 to 0.04 lower)

2598
(30 studies)

⊕⊝⊝⊝
very lowa,c,d,j,k,l,o,p

Pooled reduction is
equivalent to 1 day

The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aAllocation concealment and/or blinding of outcome assessors rated as unclear or high risk for 75% or more of included studies for this outcome
bWe did not downgrade the quality of evidence on the basis of inconsistency because a reasonable explanation was found for heterogeneity
cDirect comparisons performed on the population of interest and not a surrogate marker
dOptimal information size achieved
eNo evidence of a publication bias, or applying a correction for the possibility of publication bias would not modify the conclusion
fLarge effect size (SMD≥ 0.8)
gNo evidence of confounding factors to justify upgrading
hEffect size was proportionate to the local anaesthetic concentration
i50% or more of included studies were rated as unclear or high risk for allocation concealment and/or blinding of outcome assessors
jWe downgraded the level of evidence on inconsistency owing to a moderate amount of heterogeneity
kNo evidence of a large effect
lNo evidence of a dose‐response effect
mNo heterogeneity or heterogeneity less than 25%
nOptimal information size not achieved
oCorrecting for the possibility of publication bias would modify the conclusion
pLength of hospital stay may not adequately reflect readiness for discharge, as actual discharge may be delayed for various reasons

Figuras y tablas -
Summary of findings for the main comparison. Epidural local anaesthetic compared with opioid‐based regimen for adults
Comparison 1. Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Time to first flatus subgrouped by type of surgery Show forest plot

22

1138

Std. Mean Difference (Random, 95% CI)

‐1.28 [‐1.71, ‐0.86]

1.1 Gynaecology

3

122

Std. Mean Difference (Random, 95% CI)

‐1.24 [‐1.86, ‐0.62]

1.2 Cholecystectomy

1

27

Std. Mean Difference (Random, 95% CI)

‐0.15 [‐0.91, 0.61]

1.3 Gastrointestinal surgery

14

690

Std. Mean Difference (Random, 95% CI)

‐1.34 [‐1.82, ‐0.86]

1.4 Urology

1

40

Std. Mean Difference (Random, 95% CI)

‐0.83 [‐1.48, ‐0.17]

1.5 Vascular surgery

1

34

Std. Mean Difference (Random, 95% CI)

‐12.86 [‐15.98, ‐9.73]

1.6 Various

2

225

Std. Mean Difference (Random, 95% CI)

‐0.03 [‐0.29, 0.23]

2 Time to first faeces subgrouped according to duration of local anaesthetic administration Show forest plot

28

1559

Std. Mean Difference (Random, 95% CI)

‐0.67 [‐0.86, ‐0.47]

2.1 Epidural local anaesthetic administered during surgery only

1

30

Std. Mean Difference (Random, 95% CI)

0.03 [‐0.68, 0.75]

2.2 Epidural local anaesthetic administered postoperatively for < 48 hours

8

363

Std. Mean Difference (Random, 95% CI)

‐0.57 [‐1.06, ‐0.07]

2.3 Epidural local anaesthetic administered for ≥ 48 hours after surgery

19

1166

Std. Mean Difference (Random, 95% CI)

‐0.73 [‐0.93, ‐0.53]

3 Pain scores at rest at 6 to 8 hours after surgery subgrouped by type of surgery Show forest plot

20

947

Std. Mean Difference (Random, 95% CI)

‐0.84 [‐1.08, ‐0.61]

3.1 Cholecystectomy

1

16

Std. Mean Difference (Random, 95% CI)

0.33 [‐0.65, 1.32]

3.2 Gastrointestinal surgery

8

387

Std. Mean Difference (Random, 95% CI)

‐0.74 [‐1.06, ‐0.42]

3.3 Gynaecology

2

68

Std. Mean Difference (Random, 95% CI)

‐0.76 [‐1.70, 0.18]

3.4 Urology

4

136

Std. Mean Difference (Random, 95% CI)

‐1.16 [‐1.66, ‐0.67]

3.5 Vascular surgery

2

154

Std. Mean Difference (Random, 95% CI)

‐0.63 [‐1.00, ‐0.26]

3.6 Various

4

186

Std. Mean Difference (Random, 95% CI)

‐1.24 [‐2.18, ‐0.29]

4 Pain scores on movement at 6 to 8 hours after surgery subgrouped by type of opioid in the control group Show forest plot

13

617

Std. Mean Difference (Random, 95% CI)

‐1.05 [‐1.52, ‐0.58]

4.1 Epidural LA compared with IV or epidural fentanyl

3

119

Std. Mean Difference (Random, 95% CI)

‐1.15 [‐3.91, 1.61]

4.2 Epidural LA compared with IT (De Pietri 2006) or IV (all others) morphine

8

387

Std. Mean Difference (Random, 95% CI)

‐0.93 [‐1.28, ‐0.59]

4.3 Epidural LA with opioids compared with IV piritramide

1

19

Std. Mean Difference (Random, 95% CI)

‐0.62 [‐1.54, 0.30]

4.4 Epidural LA alone compared with epidural sufentanil

1

67

Std. Mean Difference (Random, 95% CI)

‐0.95 [‐1.78, ‐0.12]

4.5 Epidural LA with opioids compared with IV tramadol

1

25

Std. Mean Difference (Random, 95% CI)

‐2.19 [‐3.18, ‐1.20]

5 Pain scores at rest at 24 hours subgrouped by type of opioid in the epidural Show forest plot

46

3085

Std. Mean Difference (Random, 95% CI)

‐0.62 [‐0.82, ‐0.43]

5.1 Local anaesthetic only

13

414

Std. Mean Difference (Random, 95% CI)

‐0.16 [‐0.70, 0.38]

5.2 Epidural local anaesthetic with the addition of meperidine

1

59

Std. Mean Difference (Random, 95% CI)

‐0.11 [‐0.65, 0.44]

5.3 Epidural local anaesthetic with the addition of morphine

12

634

Std. Mean Difference (Random, 95% CI)

‐1.32 [‐1.87, ‐0.78]

5.4 Epidural local anaesthetic with the addition of fentanyl

18

891

Std. Mean Difference (Random, 95% CI)

‐0.55 [‐0.77, ‐0.33]

5.5 Epidural local anaesthetic with the addition of sufentanil

4

199

Std. Mean Difference (Random, 95% CI)

‐0.61 [‐0.94, ‐0.29]

5.6 Epidural with different solutions

1

888

Std. Mean Difference (Random, 95% CI)

‐0.29 [‐0.42, ‐0.15]

6 Pain scores at rest at 24 hours subgrouped by opioid in the control group Show forest plot

42

2066

Std. Mean Difference (Random, 95% CI)

‐0.69 [‐0.91, ‐0.47]

6.1 Epidural local anaesthetic compared with fentanyl

4

144

Std. Mean Difference (Random, 95% CI)

‐1.11 [‐3.18, 0.96]

6.2 Epidural local anaesthetic compared with ketobemidone

1

40

Std. Mean Difference (Random, 95% CI)

‐1.23 [‐1.91, ‐0.56]

6.3 Epidural local anaesthetic compared with piritramide

1

19

Std. Mean Difference (Random, 95% CI)

0.14 [‐0.76, 1.04]

6.4 Epidural local anaesthetic compared with meperidine

3

219

Std. Mean Difference (Random, 95% CI)

‐0.86 [‐1.73, 0.00]

6.5 Epidural local anaesthetic compared with sufentanil

1

67

Std. Mean Difference (Random, 95% CI)

0.44 [‐0.08, 0.95]

6.6 Epidural local anaesthetic compared with tramadol

2

65

Std. Mean Difference (Random, 95% CI)

‐1.09 [‐3.30, 1.12]

6.7 Epidural local anaesthetic compared with morphine

30

1435

Std. Mean Difference (Random, 95% CI)

‐0.64 [‐0.87, ‐0.41]

6.8 Epidural local anaesthetic compared with buprenorphine

2

77

Std. Mean Difference (Random, 95% CI)

‐1.05 [‐1.52, ‐0.57]

7 Pain scores on movement at 24 hours subgrouped by type of surgery Show forest plot

35

2731

Std. Mean Difference (Random, 95% CI)

‐0.85 [‐1.04, ‐0.67]

7.1 Gastrointestinal surgery

18

864

Std. Mean Difference (Random, 95% CI)

‐1.12 [‐1.43, ‐0.80]

7.2 Cholecystectomy

1

31

Std. Mean Difference (Random, 95% CI)

‐0.89 [‐1.62, ‐0.15]

7.3 Gynaecological surgery

2

144

Std. Mean Difference (Random, 95% CI)

‐0.20 [‐0.88, 0.48]

7.4 Urological surgery

4

136

Std. Mean Difference (Random, 95% CI)

‐0.66 [‐1.71, 0.40]

7.5 Vascular surgery

1

40

Std. Mean Difference (Random, 95% CI)

‐1.70 [‐2.43, ‐0.98]

7.6 Various surgeries

10

1516

Std. Mean Difference (Random, 95% CI)

‐0.61 [‐0.81, ‐0.41]

8 Pain scores on movement at 24 hours subgrouped by type of opioid in the epidural Show forest plot

34

1843

Std. Mean Difference (Random, 95% CI)

‐0.88 [‐1.09, ‐0.66]

8.1 Local anaesthetic alone

6

234

Std. Mean Difference (Random, 95% CI)

‐0.38 [‐0.93, 0.17]

8.2 Epidural meperidine

1

59

Std. Mean Difference (Random, 95% CI)

0.31 [‐0.24, 0.86]

8.3 Epidural fentanyl

16

756

Std. Mean Difference (Random, 95% CI)

‐0.95 [‐1.20, ‐0.69]

8.4 Epidural sufentanil

3

129

Std. Mean Difference (Random, 95% CI)

‐0.77 [‐1.14, ‐0.41]

8.5 Epidural morphine

10

665

Std. Mean Difference (Random, 95% CI)

‐1.19 [‐1.69, ‐0.69]

9 Pain scores on movement at 24 hours subgrouped by type of opioids in the control group Show forest plot

33

1796

Std. Mean Difference (Random, 95% CI)

‐0.90 [‐1.15, ‐0.66]

9.1 Compared with IV or epidural fentanyl

4

128

Std. Mean Difference (Random, 95% CI)

‐0.83 [‐3.13, 1.47]

9.2 Compared with sufentanil

1

67

Std. Mean Difference (Random, 95% CI)

‐0.10 [‐0.91, 0.70]

9.3 Compared with meperidine

3

219

Std. Mean Difference (Random, 95% CI)

‐0.64 [‐1.57, 0.29]

9.4 Compared with piritramide

1

19

Std. Mean Difference (Random, 95% CI)

‐0.78 [‐1.72, 0.15]

9.5 Compared with morphine

23

1249

Std. Mean Difference (Random, 95% CI)

‐0.87 [‐1.05, ‐0.69]

9.6 Compared with oxycodone

1

58

Std. Mean Difference (Random, 95% CI)

‐0.80 [‐1.33, ‐0.26]

9.7 Compared with tramadol

1

25

Std. Mean Difference (Random, 95% CI)

‐3.14 [‐4.31, ‐1.97]

9.8 Compared to buprenorphine

1

31

Std. Mean Difference (Random, 95% CI)

‐0.77 [‐1.50, ‐0.04]

10 Pain scores at rest at 48 hours subgrouped by type of solution used Show forest plot

30

2466

Std. Mean Difference (Random, 95% CI)

‐0.47 [‐0.71, ‐0.24]

10.1 Local anaesthetic alone

7

256

Std. Mean Difference (Random, 95% CI)

0.38 [‐0.49, 1.25]

10.2 Local anaesthetic with an opioid

24

2210

Std. Mean Difference (Random, 95% CI)

‐0.66 [‐0.89, ‐0.43]

11 Pain scores on movement at 48 hours subgrouped by type of solution in the epidural Show forest plot

27

2398

Std. Mean Difference (Random, 95% CI)

‐0.85 [‐1.10, ‐0.60]

11.1 Local anaesthetic alone

4

184

Std. Mean Difference (Random, 95% CI)

‐0.56 [‐1.71, 0.58]

11.2 Local anaesthetic with an opioid

23

2214

Std. Mean Difference (Random, 95% CI)

‐0.88 [‐1.13, ‐0.63]

12 Pain scores at rest at 72 hours subgrouped by type of solution used Show forest plot

15

1821

Std. Mean Difference (Random, 95% CI)

‐0.56 [‐0.88, ‐0.24]

12.1 Local anaesthetic alone

4

146

Std. Mean Difference (Random, 95% CI)

‐0.00 [‐0.34, 0.34]

12.2 Local anaesthetic plus opioids

12

1675

Std. Mean Difference (Random, 95% CI)

‐0.77 [‐1.16, ‐0.39]

13 Pain scores on movement at 72 hours subgrouped by type of solution used Show forest plot

15

1873

Std. Mean Difference (Random, 95% CI)

‐0.69 [‐0.99, ‐0.39]

13.1 Local anaesthetic alone

3

135

Std. Mean Difference (Random, 95% CI)

‐0.03 [‐0.38, 0.32]

13.2 Local anaesthetic with an opioid

12

1738

Std. Mean Difference (Random, 95% CI)

‐0.87 [‐1.22, ‐0.51]

14 Vomiting Show forest plot

22

1154

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.57, 1.23]

14.1 Gynaecological

4

223

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.06, 1.29]

14.2 Gastrointestinal

12

512

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.48, 1.32]

14.3 Various

6

419

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.44, 2.35]

15 Gastrointestinal tract anastomotic leak Show forest plot

17

848

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.41, 1.32]

16 Length of stay in hospital subgrouped by type of surgery Show forest plot

34

2774

Std. Mean Difference (Random, 95% CI)

‐0.13 [‐0.29, 0.02]

16.1 Cholecystectomy

1

20

Std. Mean Difference (Random, 95% CI)

‐0.5 [‐1.38, 0.38]

16.2 Gynaecological surgery

2

62

Std. Mean Difference (Random, 95% CI)

0.07 [‐0.43, 0.57]

16.3 Gastrointestinal surgery

18

936

Std. Mean Difference (Random, 95% CI)

‐0.11 [‐0.34, 0.12]

16.4 Urological surgery

4

141

Std. Mean Difference (Random, 95% CI)

‐0.52 [‐0.85, ‐0.18]

16.5 Vascular surgery

5

336

Std. Mean Difference (Random, 95% CI)

‐0.26 [‐0.65, 0.13]

16.6 Various surgeries

4

1279

Std. Mean Difference (Random, 95% CI)

0.16 [‐0.25, 0.57]

17 Length of stay in hospital subgrouped by surgical site for open surgery only Show forest plot

30

2598

Std. Mean Difference (Random, 95% CI)

‐0.20 [‐0.35, ‐0.04]

17.1 Open vascular surgery

5

336

Std. Mean Difference (Random, 95% CI)

‐0.26 [‐0.65, 0.13]

17.2 Open urological surgery

4

141

Std. Mean Difference (Random, 95% CI)

‐0.51 [‐0.85, ‐0.18]

17.3 Open cholecystectomy

1

20

Std. Mean Difference (Random, 95% CI)

‐0.50 [‐1.39, 0.39]

17.4 Open gynaecological surgery

2

62

Std. Mean Difference (Random, 95% CI)

0.07 [‐0.43, 0.57]

17.5 Open gastrointestinal surgery

14

760

Std. Mean Difference (Random, 95% CI)

‐0.24 [‐0.47, ‐0.01]

17.6 Open various surgeries

4

1279

Std. Mean Difference (Random, 95% CI)

0.15 [‐0.26, 0.57]

18 Costs Show forest plot

3

Std. Mean Difference (Random, 95% CI)

Subtotals only

18.1 Costs related to pain therapy only

1

62

Std. Mean Difference (Random, 95% CI)

19.96 [19.57, 20.34]

18.2 Hospital costs

2

103

Std. Mean Difference (Random, 95% CI)

0.17 [‐0.22, 0.55]

Figuras y tablas -
Comparison 1. Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen