Comparison of the analgesic efficacy between the epidural and intravenous analgesia after spinal fusion: a Meta-analysis

English Keywords:Epidural analgesia  Intravenous analgesia  Spinal fusion  Randomized controlled trial  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To compare the efficacy of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in postoperative analgesia after spinal fusion. Methods: The CNKI, Wanfang, CBM,Pubmed, Embase, Ovid, Cochrane library databases were searched by computer. The randomized controlled trails with patient-controlled epidural analgesia or patient-controlled intravenous analgesia after spinal fusion published from May 1985 to July 2013 were selected. All of them were assessed by the standard of Cochrane systematic review. Data of postoperative VAS and the rate of side effects after using the analgesic drugs were extracted into an electrical sheet, which was synthesized by a Meta-analysis with RevMan 5.2 software. Result: Eight randomized controlled trails involving 482 patients met the inclusion criteria. And the quality grade of 3 literatures was A, 5 literatures was B. The result of meta-analysis showed that: ①Visual analogue score(VAS). The postoperative first day′s VAS[WMD=－0.47, 95%CI(－0.74, －0.20)], second day′s VAS[WMD= －0.66, 95%CI(－1.14, －0.19)] showed that the patient-controlled epidural analgesia had a good analgesic effect compared with the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). No difference in the postoperative third day′s VAS[WMD=－0.58, 95%CI(－1.38, 0.21)] was observed between the two methods, and no statistic difference(P>0.05); ②The side effects. The patient-controlled epidural analgesia had a higher incidence of skin itch[RR=1.53, 95%CI(1.08, 2.16)], paresthesia[RR=3.34, 95%CI(1.12, 9.98)] after surgery than the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). While two groups had no a significant deviation about nausea[RR=1.05, 95%CI(0.79, 1.40)], vomiting[RR=0.80, 95%CI(0.48, 1.31)], and no statistic difference(P>0.05). Conclusions: The patient-controlled epidural analgesia has better analgesic effects on the postoperative first and second day after spinal fusion, but obviously has a higher incidence of skin itch and paresthesia than the patient-controlled intravenous analgesia.