FTP3.14 Comparing thoracic epidural anaesthesia to rectus sheath catheter induced analgesia in reducing postoperative pain following major abdominal surgery. A systematic review

Abstract

Abstract Aims Effective analgesia is mandatory for achieving optimum post operative recovery. The aim of this study is to compare between thoracic epidural analgesia and rectus sheath catheter analgesia in reducing pain score after open major abdominal surgery. Methods Standard medical electronic databases were searched with the support of a local librarian. Relevant published randomised controlled trials (RCT) comparing thoracic epidural analgesia and rectus sheath catheter analgesia after open major abdominal surgery, were shortlisted according to the inclusion criteria. Result Four RCTs on 351 patients undergoing major abdominal surgery were included in this meta-analysis. There were 176 patients in the thoracic epidural group (TEA) and 175 patients in the rectus sheath catheter group (RSC). In the random effect model analysis, there was no significant difference in VAS pain score in 24 hours at rest [SMD -0.46; 95% confidence interval (95% CI) -1.21 to 0.29; z =1.20 P=0.23] and movement [SMD -0.64; 95% confidence interval (95% CI) -1.69 to -0.14; z = 1.19 P= 0.23] between TEA and RSC. Similarly, there was no significant difference in pain score in 48 hours at rest [SMD -0.14; 95% confidence interval (95% CI) -0.36 to 0.08; z = 1.29 P= 0.20] and movement [SMD -0.69; 95% confidence interval (95% CI) -2.03 to 0.64; z = 1.02 P= 0.31]. Conclusion There was no significant difference in pain score between TEA and RSC following major abdominal surgery and both approaches can be used safely according to the choice and expertise available. Acknowledgement This work was previously presented.