Meng Yichen, Jiang Heng, Zhang Chenglin, Zhao Jianquan, Wang Ce, Gao Rui, Zhou Xuhui
Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
J Pain Res. 2017 Feb 14;10:405-415. doi: 10.2147/JPR.S128523. eCollection 2017.
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.
术后镇痛仍是骨科医生面临的一项挑战。本荟萃分析的目的是比较大型脊柱手术后硬膜外镇痛（EA）和静脉自控镇痛（IV-PCA）的疗效。我们检索了包括PubMed、EMBASE、Ovid和Cochrane数据库在内的电子数据库，以查找2016年6月之前发表的随机对照试验（RCT）。使用Cochrane偏倚风险工具评估纳入试验的质量。采用随机效应模型估计标准化均数差（SMD）和相对危险度（RR），以及相应的95%置信区间（CI）。还按硬膜外注入药物类型和硬膜外给药方式进行了亚组分析。共有17项试验符合纳入标准，并被选入以下荟萃分析。总体而言，与大型脊柱手术后的IV-PCA相比，EA提供了显著更好的镇痛效果、更高的患者满意度，并减少了总体阿片类药物消耗量。此外，在这两种镇痛方法相关的副作用方面未发现差异。Egger检验和Begg检验均未显示出显著的发表偏倚。我们认为，在大型脊柱手术后的疼痛管理方面，EA优于IV-PCA。需要更多大规模、高质量的试验来验证这些发现。
