Patient-controlled pethidine after major upper abdominal surgery: comparison of the epidural and intravenous routes*+

Systematic Review and Meta‐Analysis of Epidural Analgesia Versus Different Analgesic Regimes Following Oesophagogastric Resection

“…Six trials (three following gastrectomy [epidural n = 77, other analgesia n = 79] and three following oesophagectomy [epidural n = 48, other analgesia n = 45]) comparing epidural analgesia with other analgesic regimes following OG surgery were identified [16][17][18][19][20][21]. The PRISMA diagram is shown in Fig.…”

“…Two studies [16, 17] reported overall morbidity rates with no significant difference being reported between epidural analgesia and systemic opiates. Furthermore, no significant difference was observed following meta‐analysis although included numbers were small (Fig.…”

“…2). Chen et al [16] only reported morbidity of those patients discharged home and not lost to follow up. Lee et al [18] only reported specific morbidity rates and so this trial was not included in the meta‐analysis of overall morbidity.…”

“…All three trials [16–18] reported pain scores at rest at 24 h. Lee et al [17] and Chen et al [16] did not observe a significant difference between groups, whereas Zhu et al [16] observed a significantly improved pain score in the epidural group. Meta‐analysis suggested a trend towards improved pain scores at rest in the epidural group, but these results did not reach statistical significance (WMD −5.62 [95%CI −11.4 to 0.17] p = 0.06).…”

“…Meta-analysis suggested a trend towards improved pain scores at rest in the epidural group, but these results did not reach statistical significance (WMD -5.62 [95%CI -11.4 to 0.17] p = 0.06). All three studies [16][17][18] also reported dynamic pain scores. Chen et al [16] and Lee et al [18] did not observe a significant difference between epidural and non-epidural groups, whereas Zhu et al [17] reported significantly reduced pain scores in the epidural group and meta-analysis of the three trials showed significantly improved pain scores for the epidural group (Fig.…”