A comparison of the postoperative analgesic efficacy between epidural and intravenous analgesia in major spine surgery: a meta-analysis

Abstract

Postoperative analgesia remains a challenge for orthopedic surgeons. The aim of this meta-analysis is to compare the efficacy of epidural analgesia (EA) and intravenous patient-controlled analgesia (IV-PCA) following major spine surgery. We searched electronic databases, including the PubMed, EMBASE, Ovid and Cochrane databases, for randomized controlled trials (RCTs) published before June 2016. The quality of the included trials was assessed using the Cochrane risk-of-bias tool. Random effects models were used to estimate the standardized mean differences (SMDs) and relative risks (RRs), with the corresponding 95% confidence intervals (CI). Subgroup analyses stratified by the type of epidural-infused medication and epidural delivery were also performed. A total of 17 trials matched the inclusion criteria and were chosen for the following meta-analysis. Overall, EA provided significantly superior analgesia, higher patient satisfaction and decreased overall opioid consumption compared with IV-PCA following major spine surgery. Additionally, no differences were found in the side effects associated with these two methods of analgesia. Egger's and Begg's tests showed no significant publication bias. We suggest that EA is superior to IV-PCA for pain management after major spine surgery. More large-scale, high-quality trials are needed to verify these findings.

Keywords: adolescent idiopathic scoliosis; epidural analgesia; intravenous application; lumbar fusion; perioperative pain.

Figure 1

Flow chart of the process of screening of studies.

Figure 2

Summary effect of postoperative pain scores 24 hours after surgery. Notes: Diamonds represent pooled estimates, and width of the diamonds represents 95% CIs. The p-value was calculated using chi-squared test. Abbreviations: CI, confidence interval; SMD, standardized mean difference.

Figure 3

Summary effect of postoperative pain scores 48 hours after surgery. Notes: Diamonds represent pooled estimates, and width of the diamonds represents 95% CIs. The p-value was calculated using chi-squared test. Abbreviations: CI, confidence interval; SMD, standardized mean difference.

Figure 4

Summary effect of postoperative pain scores 72 hours after surgery. Notes: Diamonds represent pooled estimates, and width of the diamonds represents 95% CIs. The p-value was calculated using chi-squared test. Abbreviations: CI, confidence interval; SMD, standardized mean difference.

Figure 5

Funnel plot for the meta-analysis on the incidence of nausea and vomiting. Notes: Each point represents a separate study for the indicated association. The horizontal line indicates the effect size. Abbreviations: SE, standard error; RR, risk ratio; logRR, natural logarithm of risk ratio.