884 Optimising Analgesic Strategies in Patients Post-Oesphagectomy – a Systematic Review and Network Meta-Analysis of Randomised Clinical Trials

Abstract

Abstract Aim To perform a systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs) evaluating the optimal analgesia strategy post-oesophagectomy. Method A Network Meta-Analysis was performed according to PRISMA-NMA guidelines. Statistical analysis was performed using Shiny and R. Results 14 RCTs which included 565 patients and assessed 9 analgesia techniques were included. Relative to systemic opioids (SO), thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01−0.45) (n = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: −36.2, 95% CI: −61.44−10.96) (n = 569, 15 RCTs) and dynamic (MD: −42.90, 95% CI: −68.42−17.38) (n = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: −13.05, 95% CI: −22.74−3.36) and dynamic (MD: −18.08, 95% CI: −31.70−4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: −33.20, 95% CI: −60.57−5.83) and 48 hours (MD: −42.66, 95% CI: −59.45−25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: −5.00, 95% CI: −6.82−3.18) and time to extubation (MD: −4.40, 95% CI: −5.91−2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91−18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87−26.87). Conclusions TEA provides optimal pain control and improved post operative respiratory function in patients post-oesophagectomy, reducing ICU stays, one of the benchmarks of improved post operative recovery.