XXXX relief versus systemic opioid-based @entity158 relief for abdominal aortic surgery.

@entity1 @entity1337 @entity86 @entity158 @entity1576 @entity583 @entity360
BACKGROUND: Epidural @entity1337 offers greater @entity158 relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear. This review was originally published in 2006 and was updated in 2012 and again in 2016. OBJECTIVES: To assess the benefits and harms of @entity86 in comparison with postoperative systemic opioid-based @entity1337 for adults undergoing elective abdominal aortic surgery. SEARCH METHODS: In the updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and five trial registers in November 2014, together with reference checking to identify additional studies. SELECTION CRITERIA: We included all randomized controlled trials comparing @entity86 and postoperative systemic opioid-based @entity1337 for adults who underwent elective open abdominal aortic surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data when required. We assessed the level of evidence according to the scale provided by the GRADE working group. MAIN RESULTS: We included 15 trials published from 1987 to 2009 with 1498 @entity1 in this updated review. @entity1 had a mean age between 60.5 and 71.3 years. The percentage of @entity1 in the included studies varied from 0% to 28.1%. Adding an epidural to general anaesthesia for @entity1 undergoing abdominal aortic repair reduced @entity583 (risk ratio (RR) 0.54 (95% confidence interval (CI) 0.30 to 0.97); I(2) statistic = 0%; number needed to treat for one additional beneficial outcome (NNTB) 28 (95% CI 19 to 1423), visual or verbal analogical scale (VAS) scores up to three days after the surgery (mean difference (MD) -1.78 (95% CI -2.32 to -1.25); I(2) statistic = 0% for VAS scores on movement at postoperative day one), time to tracheal extubation (standardized mean difference (SMD) -0.42 (95% CI -0.70 to -0.15); I(2) statistic = 83%; equivalent to a mean reduction of 36 hours), @entity1576 (RR 0.69 (95% CI 0.56 to 0.85); I(2) statistic = 0%; NNTB 8 (95% CI 6 to 16)), @entity360 (OR 0.20 (95% CI 0.06 to 0.65); I(2) statistic = 0%; NNTB 32 (95% CI 27 to 74)) and time spent in the intensive care unit (SMD -0.23 (95% CI -0.41 to -0.06); I(2) statistic = 0%; equivalent to a mean reduction of six hours). We did not demonstrate a reduction in the mortality rate up to 30 days (RR 1.06 (95% CI 0.60 to 1.86); I(2) statistic = 0%). The level of evidence was low for mortality and time before tracheal extubation; moderate for @entity583 , @entity1576 and intensive care unit length of stay; and high for @entity360 and VAS scores. AUTHORS' CONCLUSIONS: Epidural @entity1337 provided better @entity158 management, reduced @entity583 , time to tracheal extubation, @entity1576 , @entity360 , and intensive care unit length of stay compared with systemic opioid-based drugs. For mortality, we did not find a difference at 30 days.
