Application of two kinds of analgesia after colorectal cancer surgery: a meta-analysis

doi:10.3969/j.issn.1674-8115.2021.10.012

Abstract

Abstract: Objective

·To explore the safety and the analgesia effect of intravenous analgesia and epidural analgesia in the patients with colorectal cancer after surgery.

Methods

·The literature search was conducted in the Chinese databases, i.e. CNKI, WanFang, CBM, and VIP, and the abroad databases, i.e. PubMed, Web of Science, Embase, Cochrane Library and Joanna Briggs Institute (JBI) for randomized controlled trials (RCTs), controlled clinical trials (CCTs) and case-control studies (CCSs) about the effects of intravenous analgesia and epidural analgesia on the patients with colorectal cancer after surgery from January 2010 to November 2020, in the languages of Chinese and English. Three researchers independently conducted literature screening and quality evaluation in strict accordance with the standards, and extracted effective data such as study type, sample size, age, intraoperative anesthesia mode, postoperative analgesic drugs and outcome indicators, which were input into RevMan 5.4 software for meta-analysis.

Results

·A total of 20 literatures, including 13 RCTs, 6 CCTs and 1 CCS, involving 1 615 patients. There were 813 cases in the epidural analgesia group and 802 cases in the intravenous analgesia group. Compared with intravenous analgesia, postoperative epidural analgesia had significant lower visual analogue scores (VAS) of pain at 6 h, 24 h, and 48 h, shorter hospital stay and time to first feeding after operation, and lower incidences of ileus and nausea and vomiting (all P<0.05).

Conclusion

·Compared with intravenous analgesia, postoperative epidural analgesia for the colorectal neoplasms patients is better in the analgesic effect 6 h, 24 h, and 48 h after surgery, effectively shortens the hospital stay and time to first feeding after operation, and reduces the incidences of ileus and nausea and vomiting.

Key words: colorectal cancer, epidural analgesia, intravenous analgesia, analgesic effect, meta-analysis

CLC Number:

R614

Zhi-ling CHEN, Chen LUO, Kang-jia ZHAO, Ling SHEN, San-lian HU. Application of two kinds of analgesia after colorectal cancer surgery: a meta-analysis[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(10): 1344-1350.

Figures/Tables 9

TrendMD

References 34

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Study	Type	Epidural analgesia				Intravenous analgesia				Outcome
Study	Type	n	Age/year	Intraoperative anesthetic	Postoperative analgesic drug	n	Age/year	Intraoperative anesthetic	Postoperative analgesic drug	Outcome
［4］	RCT	15	72.2±11.8	GA+INA	Fentanyl	15	74.7±13.8	GA+INA	Fentanyl	②③
［5］	RCT	60	51.0‒73.0	IA+GA	Diprivan， Alfentanil， Rocuronium	60	48.0‒77.0	IA+GA	Diprivan， Alfentanil， Rocuronium	③
［6］	RCT	50	50.2±5.0	EA+GA	Ropivacaine	50	50.5±6.0	IA+GA	Butorphanol tartrate	①②⑤
［7］	RCT	77	65.6	NA	Diclofenac	66	67.1	NA	Ketorolac	②
［8］	RCT	30	64.1±10.0	Light GA	Levobupivacaine， Fentanyl	30	65.8±10.0	GA	Morphine， Fentanyl	③⑤
［9］	RCT	40	26.0‒85.0	INA	Lidocaine， Ropivacaine	41	26.0‒85.0	INA	Butorphanol tartrate	①②④
［10］	RCT	81	59.1±12.1	EA+GA	Bupivacaine	81	57.6±12.1	IA+GA	Fentanyl	③⑤
［11］	RCT	37	57.5±3.1	EA+GA	Lidocaine， Ropivacaine	37	56.9±3.2	IA	Butorphanol	①④
［12］	RCT	24	54.1±2.4	EA+GA	Dezocine， Ropivacaine	24	54.2±2.4	IA	Dezocine， Fentanyl	①
［13］	RCT	31	61.0±15.0	GA	Bupivacaine， Morphine	31	58.0±16.0	IA	Morphine	②③
［14］	RCT	46	54.7±7.2	EA+GA	Sufentanil， Ropivacaine	46	53.9±6.8	IA+GA	Ondansetron， Sufentanil	①②
［15］	RCT	39	57.6±3.4	EA+GA	Lidocaine， Ropivacaine	39	57.6±3.3	IA+GA	Butorphanol	①④
［16］	RCT	32	50.3±0.9	INA	Lidocaine， Ropivacaine	32	51.1±0.8	INA	Butorphanol tartrate	①②④
［17］	CCT	30	50.2±7.3	EA+GA	Lidocaine， Ropivacaine	30	50.9±7.5	IA+GA	Butorphanol tartrate	①②④
［18］	CCT	55	55.1±3.1	EA+GA	Bupivacaine， Ephedrine	55	54.2±2.5	IA+GA	Butorphanol tartrate	①④
［19］	CCT	27	54.7±7.0	EA+GA	Bupivacaine， Ephedrine	27	54.7±6.7	IA	Butorphanol tartrate	①
［20］	CCT	30	58.6±10.2	EA+GA	Lidocaine， Ropivacaine	31	59.8±9.6	IA+GA	Butorphanol tartrate	①②④
［21］	CCT	45	55.1±1.2	IA+GA	Ropivacaine	45	56.0±1.4	IA+GA	Butorphanol	①④
［22］	CCT	24	56.5±4.7	NA	Ropivacaine	24	55.5±4.6	NA	Sufentanil	⑤
［23］	CCS	40	67.6±6.2	EA+INA	Sevoflurane	38	66.1±7.1	IA+GA	Diprivan	④⑤

Study	Type	Epidural analgesia				Intravenous analgesia				Outcome
Study	Type	n	Age/year	Intraoperative anesthetic	Postoperative analgesic drug	n	Age/year	Intraoperative anesthetic	Postoperative analgesic drug	Outcome
［4］	RCT	15	72.2±11.8	GA+INA	Fentanyl	15	74.7±13.8	GA+INA	Fentanyl	②③
［5］	RCT	60	51.0‒73.0	IA+GA	Diprivan， Alfentanil， Rocuronium	60	48.0‒77.0	IA+GA	Diprivan， Alfentanil， Rocuronium	③
［6］	RCT	50	50.2±5.0	EA+GA	Ropivacaine	50	50.5±6.0	IA+GA	Butorphanol tartrate	①②⑤
［7］	RCT	77	65.6	NA	Diclofenac	66	67.1	NA	Ketorolac	②
［8］	RCT	30	64.1±10.0	Light GA	Levobupivacaine， Fentanyl	30	65.8±10.0	GA	Morphine， Fentanyl	③⑤
［9］	RCT	40	26.0‒85.0	INA	Lidocaine， Ropivacaine	41	26.0‒85.0	INA	Butorphanol tartrate	①②④
［10］	RCT	81	59.1±12.1	EA+GA	Bupivacaine	81	57.6±12.1	IA+GA	Fentanyl	③⑤
［11］	RCT	37	57.5±3.1	EA+GA	Lidocaine， Ropivacaine	37	56.9±3.2	IA	Butorphanol	①④
［12］	RCT	24	54.1±2.4	EA+GA	Dezocine， Ropivacaine	24	54.2±2.4	IA	Dezocine， Fentanyl	①
［13］	RCT	31	61.0±15.0	GA	Bupivacaine， Morphine	31	58.0±16.0	IA	Morphine	②③
［14］	RCT	46	54.7±7.2	EA+GA	Sufentanil， Ropivacaine	46	53.9±6.8	IA+GA	Ondansetron， Sufentanil	①②
［15］	RCT	39	57.6±3.4	EA+GA	Lidocaine， Ropivacaine	39	57.6±3.3	IA+GA	Butorphanol	①④
［16］	RCT	32	50.3±0.9	INA	Lidocaine， Ropivacaine	32	51.1±0.8	INA	Butorphanol tartrate	①②④
［17］	CCT	30	50.2±7.3	EA+GA	Lidocaine， Ropivacaine	30	50.9±7.5	IA+GA	Butorphanol tartrate	①②④
［18］	CCT	55	55.1±3.1	EA+GA	Bupivacaine， Ephedrine	55	54.2±2.5	IA+GA	Butorphanol tartrate	①④
［19］	CCT	27	54.7±7.0	EA+GA	Bupivacaine， Ephedrine	27	54.7±6.7	IA	Butorphanol tartrate	①
［20］	CCT	30	58.6±10.2	EA+GA	Lidocaine， Ropivacaine	31	59.8±9.6	IA+GA	Butorphanol tartrate	①②④
［21］	CCT	45	55.1±1.2	IA+GA	Ropivacaine	45	56.0±1.4	IA+GA	Butorphanol	①④
［22］	CCT	24	56.5±4.7	NA	Ropivacaine	24	55.5±4.6	NA	Sufentanil	⑤
［23］	CCS	40	67.6±6.2	EA+INA	Sevoflurane	38	66.1±7.1	IA+GA	Diprivan	④⑤

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