Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery

Background: Epidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate. Methods: A systematic review of randomized controlled trials comparing postoperative EA and parenteral opioid analgesia after colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of length of hospital stay, pain intensity, duration of postoperative ileus, incidence of postoperative complications and side-effects. Results: Sixteen trials published between 1987 and 2005 were included. EA significantly reduced pain scores and duration of ileus (weighted mean difference -1.55 (95 percent confidence interval (c.i.) -.-27 to -0.84) days). On the other hand, it was associated with a significant increase in the incidence of pruritus (odds ratio (OR) 4.8 (95 per cent c.i. 1.3 to 17.0)), urinary retention (OR 4.3 (1.2 to 15.9)) and arterial hypotension (OR 13.5 (4.0 to 57.7)). EA did not influence duration of hospital stay. Conclusion: Despite improved analgesia and a decrease in ileus, EA has some adverse effects and does not shorten the duration of hospital stay after colorectal surgery.