Efficacy of Postoperative Epidural Analgesia: A Meta-analysis

Abstract

Context: Whether epidural analgesia is a better method than parenteral opioids for postoperative pain control remains controversial. Objective: To systematically review the efficacy of postoperative epidural analgesia vs parenteral opioids, the primary alternative technique. Data Sources: Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966 to April 25, 2002) and other sources for studies related to postoperative epidural analgesia. Study Selection: Inclusion criteria were a comparison of epidural therapy vs parenteral opioids for postoperative analgesia, measurement of pain using a visual analog scale (VAS) or numeric rating scale, randomization of patients to either therapy, and adult patients (≥18 years). A total of 1404 abstracts were identified, 100 of which met all inclusion criteria. Data Extraction: Each article was reviewed and data extracted from tables, text, or extrapolated from figures as needed. Weighted mean pain scores, weighted mean differences in pain score, and weighted incidences of complications were determined by using a fixed-effect model. Data Synthesis: Epidural analgesia provided better postoperative analgesia compared with parenteral opioids (mean [SE], 19.40 mm [0.17] vs 29.40 mm [0.20] on the VAS; P