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      Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis

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          Abstract

          Background/Purpose

          The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER.

          Methods

          We searched MEDLINE (1946–2012) and the Cochrane Library (inception–2012) for randomized controlled trials (RCT) and cohort studies comparing epidural analgesia to PCA for postoperative pain management in children following MIPER. We calculated weighted mean differences (WMD) for numeric pain scores and summarized secondary outcomes qualitatively.

          Results

          Of 699 studies, 3 RCTs and 3 retrospective cohorts met inclusion criteria. Compared to PCA, mean pain scores were modestly lower with epidural immediately (WMD −1.04, 95% CI −2.11 to 0.03, p = 0.06), 12 hours (WMD −1.12; 95% CI −1.61 to −0.62, p < 0.001), 24 hours (WMD −0.51, 95%CI −1.05 to 0.02, p = 0.06), and 48 hours (WMD −0.85, 95% CI −1.62 to −0.07, p = 0.03) after surgery. We found no statistically significant differences between secondary outcomes.

          Conclusions

          Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.

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          Author and article information

          Journal
          0052631
          5138
          J Pediatr Surg
          J. Pediatr. Surg.
          Journal of pediatric surgery
          0022-3468
          1531-5037
          24 January 2017
          22 February 2014
          May 2014
          17 February 2017
          : 49
          : 5
          : 798-806
          Affiliations
          [a ]The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
          [b ]The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH 03755, USA
          [c ]Section of Vascular Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
          [d ]Section of Pediatric Surgery, Department of Surgery, Geisel School of Medicine, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
          Author notes
          [* ]Corresponding author at: Dartmouth-Hitchcock Medical Center, Division of General Surgery, One Medical Center Drive, Lebanon, NH 03756. Tel.: +1 608 698 0760. Andrea.M.Stroud@ 123456hitchcock.org (A.M. Stroud)
          Article
          PMC5315444 PMC5315444 5315444 nihpa845173
          10.1016/j.jpedsurg.2014.02.072
          5315444
          24851774
          c8158cbb-ec99-48ca-a9c0-ef97d8dbbade
          History
          Categories
          Article

          Minimally invasive pectus excavatum repair,Nuss,Pain control,Epidural,Analgesia

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