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Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery
| Content Provider | Scilit |
|---|---|
| Author | Guay, Joanne Nishimori, Mina Kopp, Sandra |
| Copyright Year | 2016 |
| Description | Journal: Cochrane Database of Systematic Reviews |
| Abstract | Gastrointestinal paralysis, nausea and vomiting and pain are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization and hospital costs. This review was first published in 2001 and was updated by new review authors in 2016. To compare effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of anastomotic leak, length of hospital stay and costs after abdominal surgery. We identified trials by conducting computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), MEDLINE (from 1950 to December 2014) and EMBASE (from 1974 to December 2014) and by checking the reference lists of trials retained. When we reran the search in February 2016, we added 16 potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate these studies into formal review findings during the next review update. We included parallel randomized controlled trials comparing effects of postoperative epidural local anaesthetic versus regimens based on systemic or epidural opioids. We rated the quality of studies by using the Cochrane 'Risk of bias' tool. Two review authors independently extracted data and judged the quality of evidence according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) scale. We included 128 trials with 8754 participants in the review, and 94 trials with 5846 participants in the analysis. Trials included in the review were funded as follows: charity (n = 19), departmental resources (n = 8), governmental sources (n = 15) and industry (in part or in total) (n = 15). The source of funding was not specified for the other studies. Results of 22 trials including 1138 participants show that an epidural containing a local anaesthetic will decrease the time required for return of gastrointestinal transit as measured by time to first flatus after an abdominal surgery (standardized mean difference (SMD) -1.28, 95% confidence interval (CI) -1.71 to -0.86; high quality of evidence; equivalent to 17.5 hours). The effect is proportionate to the concentration of local anaesthetic used. A total of 28 trials including 1559 participants reported a decrease in time to first faeces (stool) (SMD -0.67, 95% CI -0.86 to -0.47; low quality of evidence; equivalent to 22 hours). Thirty-five trials including 2731 participants found that pain on movement at 24 hours after surgery was also reduced (SMD -0.89, 95% CI -1.08 to -0.70; moderate quality of evidence; equivalent to 2.5 on scale from 0 to 10). From findings of 22 trials including 1154 participants we did not find a difference in the incidence of vomiting within 24 hours (risk ratio (RR) 0.84, 95% CI 0.57 to 1.23; low quality of evidence). From investigators in 17 trials including 848 participants we did not find a difference in the incidence of gastrointestinal anastomotic leak (RR 0.74, 95% CI 0.41 to 1.32; low quality of evidence). Researchers in 30 trials including 2598 participants noted that epidural analgesia reduced length of hospital stay for an open surgery (SMD -0.20, 95% CI -0.35 to -0.04; very low quality of evidence; equivalent to one day). Data on costs were very limited. An epidural containing a local anaesthetic, with or without the addition of an opioid, accelerates the return of gastrointestinal transit (high quality of evidence). An epidural containing a local anaesthetic with an opioid decreases pain after abdominal surgery (moderate quality of evidence). We did not find a difference in the incidence of vomiting or anastomotic leak (low quality of evidence). For open surgery, an epidural containing a local anaesthetic would reduce the length of hospital stay (very low quality of evidence). Anestésicos locales epidurales versus regímenes analgésicos con opiáceos para la parálisis gastrointestinal, los vómitos y el dolor después de la cirugía abdominal La parálisis gastrointestinal, náuseas y vómitos, y el dolor, son problemas clínicos importantes después de la cirugía abdominal. Las técnicas anestésicas y analgésicas que alivian el dolor y las náuseas y los vómitos posoperatorios (NVPO), mientras previenen o reducen el íleo posoperatorio, pueden reducir la morbilidad posoperatoria, la duración de la hospitalización y los costos hospitalarios. Esta revisión fue publicada por primera vez en 2001 y fue actualizada por los nuevos autores de la revisión en 2016. Comparar los efectos de la analgesia epidural posoperatoria con anestésicos locales versus opiáceos posoperatorios sistémicos o epidurales en cuanto al retorno del tránsito gastrointestinal, el control del dolor posoperatorio, los vómitos posoperatorios, la incidencia de pérdida anastomótica, la duración de la estancia hospitalaria y los costos después de la cirugía abdominal. Los ensayos se identificaron mediante la realización de búsquedas electrónicas en el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL) (2014, número 12), MEDLINE (desde 1950 hasta diciembre 2014), en EMBASE (desde 1974 hasta diciembre 2014) y mediante verificación de las listas de referencias de los ensayos recuperados. Cuando se repitió la búsqueda en febrero de 2016, se agregaron 16 estudios nuevos de interés potencial a la lista de “Estudios en espera de... |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457860/pdf http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001893.pub2/pdf |
| ISSN | 1469493X |
| e-ISSN | 14651858 |
| DOI | 10.1002/14651858.cd001893.pub2 |
| Journal | Cochrane Database of Systematic Reviews |
| Issue Number | 1 |
| Volume Number | 2017 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2016-07-15 |
| Access Restriction | Open |
| Subject Keyword | Journal: Cochrane Database of Systematic Reviews Anesthesia, Epidural Analgesics, Opioid Analgesics, Opioid/therapeutic Use Anesthetics, Local Anesthetics, Local/therapeutic Use Gastrointestinal Diseases Gastrointestinal Diseases/drug Therapy Gastrointestinal Diseases/etiology Gastrointestinal Transit Gastrointestinal Transit/drug Effects Pain, Postoperative Pain, Postoperative/drug Therapy Paralysis/drug Therapy Paralysis/etiology Postoperative Complications |
| Content Type | Text |
| Resource Type | Article |
