PMID- 34739706
OWN - NLM
STAT- MEDLINE
DCOM- 20220407
LR  - 20220407
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 69
IP  - 1
DP  - 2022 Jan
TI  - Comparison of analgesic modalities for patients undergoing midline laparotomy: a 
      systematic review and network meta-analysis.
PG  - 140-176
LID - 10.1007/s12630-021-02128-6 [doi]
AB  - BACKGROUND: Midline laparotomy is associated with severe pain. Epidural analgesia 
      has been the established standard, but multiple alternative regional anesthesia 
      modalities are now available. We aimed to compare continuous and single-shot 
      regional anesthesia techniques in this systematic review and network 
      meta-analysis. METHODS: We included randomized controlled trials on adults who 
      were scheduled for laparotomy with solely a midline incision under general 
      anesthesia and received neuraxial or regional anesthesia for pain. Network 
      meta-analysis was performed with a frequentist method, and continuous and 
      dichotomous outcomes were presented as mean differences and odds ratios, 
      respectively, with 95% confidence intervals. The quality of evidence was rated 
      with the  grading of recommendations, assessment, development, and evaluation 
      system. RESULTS: Overall, 36 trials with 2,056 patients were included. None of 
      the trials assessed erector spinae plane or quadratus lumborum block, and rectus 
      sheath blocks and transversus abdominis plane blocks were combined into abdominal 
      wall blocks (AWB). For the co-primary outcome of pain score at rest at 24 hr, 
      with a minimal clinically important difference (MCID) of 1, epidural was 
      clinically superior to control and single-shot AWB; epidural was statistically 
      but not clinically superior to continuous wound infiltration (WI); and no 
      statistical or clinical difference was found between control and single-shot AWB. 
      For the co-primary outcome of cumulative morphine consumption at 24 hr, with a 
      MCID of 10 mg, epidural and continuous AWB were clinically superior to control; 
      epidural was clinically superior to continuous WI, single-shot AWB, single-shot 
      WI, and spinal; and continuous AWB was clinically superior to single-shot AWB. 
      The quality of evidence was low in view of serious limitations and imprecision. 
      Other results of importance included: single-shot AWB did not provide clinically 
      relevant analgesic benefit beyond two hr; continuous WI was clinically superior 
      to single-shot WI by 8-12 hr; and clinical equivalence was found between 
      epidural, continuous AWB, and continuous WI for the pain score at rest, and 
      epidural and continuous WI for the cumulative morphine consumption at 48 hr. 
      CONCLUSIONS: Single-shot AWB were only clinically effective for analgesia in the 
      early postoperative period. Continuous regional anesthesia modalities increased 
      the duration of analgesia relative to their single-shot counterparts. Epidural 
      analgesia remained clinically superior to alternative continuous regional 
      anesthesia techniques for the first 24 hr, but reached equivalence, at least with 
      respect to static pain, with continuous AWB and WI by 48 hr. TRIAL REGISTRATION: 
      PROSPERO (CRD42021238916); registered 25 February 2021.
CI  - (c) 2021. Canadian Anesthesiologists' Society.
FAU - Howle, Ryan
AU  - Howle R
AUID- ORCID: 0000-0001-6172-2101
AD  - Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, 
      Ireland. ryanhowle@doctors.org.uk.
FAU - Ng, Su-Cheen
AU  - Ng SC
AD  - Department of Anaesthesia, Beacon Hospital, Dublin, Ireland.
FAU - Wong, Heung-Yan
AU  - Wong HY
AD  - Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
FAU - Onwochei, Desire
AU  - Onwochei D
AD  - Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
AD  - King's College London, London, UK.
FAU - Desai, Neel
AU  - Desai N
AD  - Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
AD  - King's College London, London, UK.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
TT  - Comparaison des modalites analgesiques pour les patients beneficiant d'une 
      laparotomie mediane : une revue systematique et meta-analyse en reseau.
DEP - 20211105
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Analgesics)
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Abdominal Muscles
MH  - Adult
MH  - *Analgesia, Epidural
MH  - Analgesics
MH  - Analgesics, Opioid
MH  - Humans
MH  - *Laparotomy
MH  - Network Meta-Analysis
MH  - Pain, Postoperative/drug therapy
OTO - NOTNLM
OT  - analgesia, epidural
OT  - laparotomy
OT  - nerve block
OT  - network meta-analysis
OT  - pain management
EDAT- 2021/11/06 06:00
MHDA- 2022/04/08 06:00
CRDT- 2021/11/05 17:27
PHST- 2021/07/01 00:00 [received]
PHST- 2021/09/08 00:00 [accepted]
PHST- 2021/09/08 00:00 [revised]
PHST- 2021/11/06 06:00 [pubmed]
PHST- 2022/04/08 06:00 [medline]
PHST- 2021/11/05 17:27 [entrez]
AID - 10.1007/s12630-021-02128-6 [pii]
AID - 10.1007/s12630-021-02128-6 [doi]
PST - ppublish
SO  - Can J Anaesth. 2022 Jan;69(1):140-176. doi: 10.1007/s12630-021-02128-6. Epub 2021 
      Nov 5.