Thoracic epidural analgesia (TEA) versus patient-controlled analgesia (PCA) in laparoscopic colectomy: a systematic review and meta-analysis

PurposeA meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy.MethodsOur study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Fixed effects (FE) or random effects (RE) models were estimated based on the Cochran Q test result.ResultsTotally, 8 studies were introduced in the present meta-analysis. Superiority of PCA in terms of length of hospital stay (LOS) (WMD 0.73, p=0.004) and total complication rate (OR 1.57, p=0.02) was found. TEA had a lower resting pain visual analogue scale (VAS) score at Day 1 (WMD -2.23, p=0.005) and Day 2 (WMD -2.17, p=0.01). TEA group had also a systematically lower walking VAS. Moreover, first bowel opened time (first defecation) (WMD -0.88, p<0.00001) was higher when PCA was applied.ConclusionsTEA was related to a lower first bowel opened time, walking, and resting pain levels at the first postoperative days. However, the overall complication rate and LOS were higher in the epidural analgesia group. Thus, for a safe conclusion to be drawn, further randomized controlled trials (RCTs) of a higher methodological and quality level are required.