Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

Table 1

Summary of studies’ characteristics.

Authors	Studies	Interventions	Alternative to epidural	Number of patients with epidural/alternative analgesia	Epidural protocol	Alternative protocol	Hypothesis	Main measured outcome
Turunen et al. 2009 [7]	Open RCT	Laparoscopic sigmoidectomy for diverticular diseases	Epidural on add-on to opioids	29/29	Daily doses: Ketoprofen 100 mg × 3; Paracetamol 1 gr × 4; If needed; Oxycodone 0,05 mg/kg IV or 0,15 mg/kg IM; +; Epidural infusion; Ropivacaina 2 mg/mL at 4 to 10 mL/h for 2 days	Daily doses: Ketoprofen 100 mg × 3; Paracetamol 1 gr × 4; If needed; Oxycodone 0,05 mg/kg IV or 0,15 mg/kg IM	Epidural analgesia reduced use of opioids and therefore advanced postoperative outcomes	Postoperative IV Oxycodone consumption
Levy et al. 2011 [8]	Subgroup analysis within a triple comparison in open RCT; patients with stoma excluded	Laparoscopic colorectal surgery for benign and malignant diseases	PCA	30/30	Diclofenac 50 mg × 3; Paracetamol 1 gr × 4; In case of allergy: Tramadol 50–100 mg or Morphine 2.5–10 mg; +; Epidural infusion; Bupivacaine 0.15%; Fentanyl 0.0002%; 4–8 mL/h for 2 days	Diclofenac 50 mg × 3; Paracetamol 1 gr × 4; In case of allergy: Tramadol 50–100 mg or Morphine 2.5–10 mg; +; PCA pump; Morphine maximum dose 20 mg every 4 hours	Exploration of the effects of different analgesic regimens on postoperative outcomes	Length of postoperative stay
Wongyingsinn et al. 2011 [9]	Open RCT; Included patients with ileostomy	Laparoscopic colorectal surgery	IV Lidocaine infusion	30/30	Acetaminophen 1 gr × 4; Naproxen 500 mg × 2; +; Epidural infusion; Bupivacaine 0.1%; Morphine 0.02 mg/mL for 2 days	Acetaminophen 1 gr × 4; Naproxen 500 mg × 2; +; IV catheter; Lidocaine 2 mg/kg per hour; As recue PCA IV catheter 1-2 mg Morphine every 7 minutes	Comparison of epidural analgesia and IV Lidocaine infusion	Return to bowel function
Boulind et al. 2013 [10]	Pilot study of blinded RCT	Laparoscopic colorectal surgery for benign and malignant diseases	Wound infusion catheter (WIC)	14/17	Epidural infusion; Doses not reported	Wound catheter infusion; Doses not reported	Feasibility of a large RCT comparing epidural analgesia and WIC	No main primary outcome
Hübner et al. 2015 [11]	Open RCT	Elective colorectal surgery	PCA	65/57	Metamizole 500 mg × 4; Paracetamol 1 gr × 4; +; Epidural infusion; Bupivacaine 0.1%; Fentanyl 2 g/mL; Adrenaline 2 g/mL; +; 3 mL bolus every 40 minutes	Metamizole 500 mg × 4; Paracetamol 1 gr × 4; +; PCA IV catheter; Fentanyl 1 mg/h; +; 1 mL bolus every 5 minutes up to 40 mg/4 h	Superiority of epidural over PCA	Mean reduction of medical recovery time

RCT: randomised clinical trial.
WIC: wound infusion catheter.
PCA: patient controlled analgesia.
IV: intravenous.
IM: intramuscular.