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Epidural versus local anaesthetic infiltration via wound catheters in open liver resection: A meta-analysis

Lookup NU author(s): Sanjay PandanaboyanaORCiD


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© 2014 Royal Australasian College of Surgeons.This meta-analysis was designed to systematically analyse all published studies comparing local anaesthetic infiltration with wound catheters and epidural catheters in open liver resection. Methods: A literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. Randomized trials, and prospective and retrospective studies comparing wound catheters with epidural catheters were included. Statistical analysis was performed using Review Manager Version 5.2 software. The primary outcome measures were pain scores in the post-operative period operation. Secondary outcome measures were hospital stay, time to opening bowels, overall complications and analgesia-specific complications. Results: Four studies including 705 patients were included in the analysis. The pain scores were significantly lower in those patients with epidural on the first post-operative day (POD) (mean difference of -0.90 [-1.29, -0.52], Z=4.61) (P<0.00001) with comparable pain scores on PODs 2 and 3. There was no significant difference in the time to opening bowels, opioid use and hospital stay between the techniques. The post-operative complication rate was higher in the epidural group (risk ratio 1.40 [1.07, 1.83]; χ2=0.60, df=1) (P=0.44); I2=0%; Z=2.42 (P=0.02). Conclusion: Local anaesthetic infiltration via wound catheters combined with patient-controlled opiate analgesia provides comparable pain relief to epidural catheters except for the first POD. Both techniques are associated with similar hospital stay and opioid use with wound catheters associated with lower complication rate.

Publication metadata

Author(s): Bell R, Pandanaboyana S, Prasad KR

Publication type: Review

Publication status: Published

Journal: ANZ Journal of Surgery

Year: 2015

Volume: 85

Issue: 1-2

Pages: 16-21

Online publication date: 29/05/2014

Acceptance date: 22/04/2014

ISSN (print): 1445-1433

ISSN (electronic): 1445-2197

Publisher: Blackwell Publishing


DOI: 10.1111/ans.12683

PubMed id: 24888251