Thoracic epidural analgesia (TEA) vs. patient controlled analgesia (PCA) in laparoscopic colectomy: a meta-analysis

Use of thoracic epidural analgesia (TEA) in laparoscopic colorectal surgery is still controversial. Previous clinical trials have conflicting findings in terms of bowel function return, length of hospital stay and postoperative complications. This meta-analysis aims to assess the effect of TEA on clinical outcomes of laparoscopic colorectal surgery compared with patient controlled analgesia (PCA).

Randomized, controlled trials (RCTs) compared the effect of thoracic epidural analgesia (TEA) and patient controlled analgesia (PCA) on outcomes of laparoscopic colorectal surgery was searched. The effects on pain relief, bowel function return, length of hospital stay and post-operative complications were compared.

Seven RCTs were included in this meta-analysis. Compared with PEA, TEA contributed significantly lower visual analog scale (VAS) or verbal rate scale (VRS) pain score during the initial period after surgery. No significant difference was observed in time to return of bowel function and length of hospital stay between the two groups. TEA group was associated with lower risk in nausea and vomiting, but with similar risk in urinary retention, urinary tract infection, wound infection, ileus and anastomotic leakage compared with PCA group.

Use of epidural analgesia in laparoscopic colorectal surgery helps to provide better pain alleviation during the initial period after operation. This benefit is not at the expense of increased risks of any major complications, or significantly longer hospital stay. No significant benefits in return of bowel function were observed.