Meta‐analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery

@article{Marret2007MetaanalysisOE,
  title={Meta‐analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery},
  author={Emmanuel Marret and Camille Remy and Francis J Bonnet},
  journal={British Journal of Surgery},
  year={2007},
  volume={94}
}
Epidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate. 
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References

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This randomized clinical trial compared the use of thoracic epidural anaesthesia–analgesia (TEA) with morphine patient‐controlled analgesia (PCA) for pain relief after laparoscopic colectomy.
Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection
The aim of the study was to evaluate whether perioperative epidural analgesia had any effect on the duration of postoperative ileus after laparoscopic sigmoid resection.
Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery
TLDR
This study highlights the need to select patients suitable for vaginal or laparoscopic mesh placement for analgesia prior to and after colonic surgery on the basis of prior history and once they provide informed consent for surgery.
Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition
TLDR
Multimodal rehabilitation with epidural analgesia, early oral feeding, mobilization and laxative use after colonic resection has reduced ileus and hospital stay.
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The aim of this review was to assess FT programmes for elective segmental colonic resections to accelerate recovery, reduce morbidity and shorten hospital stay.
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Thoracic epidural analgesia has distinct advantages over patient-controlled analgesia morphine in providing superior quality of analgesia and shortening the duration of postoperative ileus, however, discharge home was not faster, indicating that other perioperative factors influence the length of hospital stay.
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TLDR
Administration of epidural local anaesthetics to patients undergoing laparotomy reduce gastrointestinal paralysis compared with systemic or epidural opioids, with comparable postoperative pain relief.
Incidence of Neurologic Complications Related to Thoracic Epidural Catheterization
TLDR
The incidence of neurologic complications occurring after thoracic epidural catheterization was studied and the risk:benefit ratio of thoracIC epidural analgesia is controversial.
Effect of Epidural Anesthesia and Analgesia on Perioperative Outcome: A Randomized, Controlled Veterans Affairs Cooperative Study
TLDR
The effect of anesthetic and postoperative analgesic techniques on perioperative outcome varies with the type of operation performed, but overall, epidural analgesia provides better postoperative pain relief.
Postoperative Pulmonary Complications Epidural Analgesia Using Bupivacaine and Opioids Versus Parenteral Opioids
TLDR
Epidural analgesia with a combination of local anesthetic and opioid improves patient comfort, however, this type of analgesia does not decrease the incidence of postoperative pulmonary complications, does not reduce the length of the hospital stay, and carries the risk of complications from episodic systemic hypotension.
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