COMPARISON OF WOUND INFUSION CATHETER VERSUS EPIDURAL CATHETER FOR ANALGESIA AFTER MIDLINE INCISION FOR MAJOR ABDOMINAL SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS. dr.aliyasen1@gmail.com

 

COMPARISON OF WOUND INFUSION CATHETER VERSUS EPIDURAL CATHETER FOR ANALGESIA AFTER MIDLINE INCISION FOR MAJOR ABDOMINAL SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS.

8

United Kingdom

Oral only

To evaluate comparative outcomes of continuous wound infusion catheter (WC) versus Epidural analgesia (EP) for analgesia after laparotomy for major abdominal surgery.

A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all randomised controlled trials comparing continuous wound infusion catheter versus Epidural infusion for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and Length of hospital stay (LOS) were set as outcome parameters for the meta-analysis.

Twelve RCTs were pooled in a meta-analysis, involving a total of 778 patients who received WC (n=390) or EP (n=388). There was no difference in pain scores at rest and movement between the two groups at 24-hour [P=0.85 and P=0.30, respectively] and 48-hour [P=0.33 and P=0.06, respectively]. However, subgroup analysis excluding subcutaneous catheters showed favourable pain scores on movement at 48 hours of use (MD-0.97,P=0.03). The LOS was shorter in the WC group [MD,-0.50;P=0.00001](Figure 1). There were no significant differences in cumulative Morphine consumption [P=0.33], return of bowel function [P=0.13], respiratory depression [P=0.43] or catheter site infection [P=0.16].

WC provides comparable postoperative analgesia to EP; however, it is associated with a shorter hospital stay following midline laparotomy. Although there is a trend of reduced opiate use and catheter-related complications in some studies, this was not evident from the pooled data.