Introduction/Background Gynecological oncological surgery is highly complex and, together with the extension of surgical incision, is responsible for the surgical-stress response. Both surgery and anesthesia cause immunodepression, compromising cell-mediated and innate immunity. Pain increases tumor-promoting effects of surgery, suppresses cell-mediated immunity and activates endocrine-metabolic responses, contributing to organ dysfunctions. A reduction in surgical-stress response and pain could lead to surgical outcomes improvement.
Methodology We performed a network meta-analysis based on random effects model for mixed multiple treatment. MEDLINE was searched for all articles containing text-words epidural analgesia(EA) and gynecological cancer (1989-October2022), comparing EA versus other methods of post-operative pain control. Primary outcome was the mean postoperative pain after 0–24 and48-hours in patients operated for gynecological cancer by laparotomy, according to different methods of postoperative pain control. Secondary outcome was postoperative complications rate.
Results Five studies (1150 women) analyzed postoperative pain within 24 hours. Patient-controlled EA (PCEA), patient-controlled analgesia(PCA), transversus abdominis plane (TAP) block and EA were directly and indirectly evaluated. A significant reduction of pain was achieved with PCEA relative to PCA [MD -2.28(95%CI -3.58--0.97)]. SUCRA(Surface Under the Cumulative Ranking curve Area) analysis ranking showed that PCEA had the highest chances to be ranked as first-choice (SUCRA=69.9%). No significant differences related to treatment options after 24h and 48h (12 and 7 studies respectively) were highlighted. In post-operative pain after 48h, PCEA received the greatest SUCRA score of all options (SUCRA=69.4%), indicating that it had the best possibility of being rated first. Thirteen studies reported on post-operative complications. No appreciable differences were detected. PCEA had the highest SUCRA score (SUCRA=89.2%) of all the options, showing less postoperative complications.
Conclusion PCEA showed a significant reduction in post-operative pain control within 24 hours. Although not significant, PCEA had the greatest possibility of being rated as best option for pain-control after 48h and showed less post-operative complications rate.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.