Key result
Relative to systemic opioids, thoracic epidural analgesia significantly reduced static pain scores at 24 hours post-esophagectomy (MD -13.73; 95% CI -27.01 to 0.45).
Why the study?
Optimal pain control following esophagectomy remains a topic of contention.
Do regional analgesia techniques like thoracic epidural analgesia improve pain control compared to systemic opioids in patients post-esophagectomy?
Systematic Review (n=565)
Do regional analgesia techniques like thoracic epidural analgesia improve pain control compared to systemic opioids in patients post-esophagectomy?
Mean Difference: -13.73 (95% CI -27.01–0.45)
Thoracic epidural analgesia provides optimal pain control, improves respiratory function, and reduces ICU stay compared to systemic opioids following esophagectomy.
TEA optimizes post-esophagectomy pain control, respiratory function, and ICU stay; extends RCT network evidence for thoracic procedures.
Optimal pain control following esophagectomy remains a topic of contention. The aim was to perform a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating the analgesia strategies post-esophagectomy. A NMA was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using Shiny and R. Fourteen RCTs which included 565 patients and assessed nine analgesia techniques were included. Relative to systemic opioids, thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): -13.73, 95% Confidence Interval (CI): -27.01-0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: -36.2, 95% CI: -61.44-10.96) (n = 569, 15 RCTs) and dynamic (MD: -42.90, 95% CI: -68.42-17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: -13.05, 95% CI: -22.74-3.36) and dynamic (MD: -18.08, 95% CI: -31.70-4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: -33.20, 95% CI: -60.57-5.83) and 48 hours (MD: -42.66, 95% CI: -59.45-25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: -5.00, 95% CI: -6.82-3.18) and time to extubation (MD: -4.40, 95% CI: -5.91-2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91-18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87-26.87). TEA provides optimal pain control and improved post-operative respiratory function in patients post-esophagectomy, reducing ICU stays, one of the benchmarks of improved post-operative recovery. IPA demonstrates promising results for potential implementation in the future following esophagectomy.
No takes yet. Share an insight, caveat, or question.
Ramjit et al. (2024) conducted a systematic review in post-esophagectomy (n=565). Thoracic epidural analgesia (TEA) vs. Systemic opioids was evaluated on Static pain scores at 24 hours post-operatively (MD -13.73, 95% CI -27.01 to 0.45). Relative to systemic opioids, thoracic epidural analgesia significantly reduced static pain scores at 24 hours post-esophagectomy (MD -13.73; 95% CI -27.01 to 0.45).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: