Nishimori M, Ballantyne J C, Low J H S
Massachusetts General Hospital, MGH Anesthesia Statistics Research Laboratory, 101 Merrimac Street, Suite 610,Boston, MA 02114, USA.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD005059. doi: 10.1002/14651858.CD005059.pub2.
Epidural analgesia offers greater pain relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear.
To assess the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid-based pain relief for adult patients who underwent elective abdominal aortic surgery.
We searched the Cochrane Central Register of Controlled Trials via OVID (CENTRAL) (The Cochrane Library, Issue 3, 2004); OVID MEDLINE (1966 to July 2004); and EMBASE (1980 to June 2004). We assessed non-English language reports and contacted researchers in the field. We did not seek unpublished data.
We included all randomized controlled trials comparing postoperative epidural analgesia and postoperative systemic opioid-based analgesia for adult patients who underwent elective open abdominal aortic surgery.
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data.
Thirteen studies involving 1224 patients met our inclusion criteria; 597 patients received epidural analgesia and 627 received systemic opioid analgesia. The epidural analgesia group showed significantly lower visual analogue scale for pain on movement (up to postoperative day three), regardless of the site of epidural catheter and epidural formulation. Postoperative duration of tracheal intubation and mechanical ventilation was significantly shorter by about 20% in the epidural analgesia group. The overall incidence of cardiovascular complication; myocardial infarction; acute respiratory failure (defined as an extended need for mechanical ventilation); gastrointestinal complication; and renal insufficiency was significantly lower in the epidural analgesia group, especially in trials that used thoracic epidural analgesia.
AUTHORS' CONCLUSIONS: Epidural analgesia provides better pain relief (especially during movement) for up to three postoperative days. It reduces the duration of postoperative tracheal intubation by roughly 20%. The occurrence of prolonged postoperative mechanical ventilation, overall cardiac complication, myocardial infarction, gastric complication and renal complication was also reduced by epidural analgesia, especially thoracic. However, current evidence does not confirm the beneficial effect of epidural analgesia on postoperative mortality and other types of complications.
与全身性阿片类药物相比，硬膜外镇痛能提供更好的疼痛缓解效果，但其对发病率和死亡率的影响尚不清楚。
评估择期腹主动脉手术成年患者术后硬膜外镇痛与术后全身性阿片类药物镇痛相比的益处和危害。
我们通过OVID检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》，2004年第3期）；OVID MEDLINE（1966年至2004年7月）；以及EMBASE（1980年至2004年6月）。我们评估了非英语语言报告并联系了该领域的研究人员。我们未寻求未发表的数据。
我们纳入了所有比较择期开放性腹主动脉手术成年患者术后硬膜外镇痛与术后全身性阿片类药物镇痛的随机对照试验。
两位作者独立评估试验质量并提取数据。我们联系研究作者获取更多信息和数据。
13项涉及1224例患者的研究符合我们的纳入标准；597例患者接受硬膜外镇痛，627例接受全身性阿片类药物镇痛。硬膜外镇痛组在运动时的视觉模拟疼痛评分显著更低（直至术后第3天），无论硬膜外导管位置和硬膜外配方如何。硬膜外镇痛组术后气管插管和机械通气时间显著缩短约20%。硬膜外镇痛组心血管并发症、心肌梗死、急性呼吸衰竭（定义为机械通气需求延长）、胃肠道并发症和肾功能不全的总体发生率显著更低，尤其是在使用胸段硬膜外镇痛的试验中。
硬膜外镇痛在术后三天内提供更好的疼痛缓解（尤其是运动时）。它将术后气管插管时间缩短约20%。硬膜外镇痛还降低了术后长时间机械通气、总体心脏并发症、心肌梗死、胃部并发症和肾脏并发症的发生率，尤其是胸段硬膜外镇痛。然而，目前的证据未证实硬膜外镇痛对术后死亡率和其他类型并发症的有益作用。
