ReviewPerioperative medicine (London, England)2024
A systematic review and meta-analysis of thoracic epidural analgesia versus other analgesic techniques in patients post-oesophagectomy.
Review in Perioperative medicine (London, England), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Ultrasound image-based paravertebral nerve block combined with general anesthesia in laparoscopic radical resection of esophageal cancer : Paravertebral nerve block versus general anesthesia in the treatment of esophageal cancer: a randomized controlled trial.World journal of surgical oncology · 2025Trial
- Vasoactive-inotropic score and major cardiovascular events in patients undergoing esophagectomy: a retrospective analysis of intravenous lidocaine and thoracic epidural anesthesia.BMC anesthesiology · 2026Article
- Thoracic Epidural Analgesia in Major Cancer Surgery: An Update.Medicina (Kaunas, Lithuania) · 2026Review
- Impact of nonintubated versus intubated anesthesia on postoperative pulmonary complications after video-assisted thoracoscopic lung resection: A retrospective cohort study.The Journal of international medical research · 2026Article
- Effects of Peripheral Nerve Block on Perioperative Recovery following Major Thoracic and Abdominal Surgery: A Retrospective Cohort Study With Propensity-score Matching.Annals of surgery · 2026Article
- Evolution and refinements in minimally invasive esophagectomy: a narrative review.Journal of thoracic disease · 2026Review
- Epidurals in esophagectomy: end of an era?Journal of thoracic disease · 2026Article
- Rethinking Thoracotomy Analgesia: Paravertebral Block Versus Thoracic Epidural Analgesia in Real-World Practice.Cureus · 2025Article
- [Epidural Analgesia in Minimally Invasive Esophagectomy: Evidence and Practice].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2025Review
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3 authors.
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Abstract
backgroundOesophageal cancer surgery represents a high perioperative risk of complications to patients, such as postoperative pulmonary complications (PPCs). Postoperative analgesia may influence these risks, but the most favourable analgesic technique is debated. This review aims to provide an updated evaluation of whether thoracic epidural analgesia (TEA) has benefits compared to other analgesic techniques in patients undergoing oesophagectomy surgery. Our hypothesis is that TEA reduces pain scores and PPCs compared to intravenous opioid analgesia in patients post-oesophagectomy.
methodsElectronic databases PubMed, Excerpta Medica Database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomised trials of analgesic interventions in patients undergoing oesophagectomy surgery. Only trials including thoracic epidural analgesia compared with other analgesic techniques were included. The primary outcome was a composite of respiratory infection, atelectasis and respiratory failure (PPCs), with pain scores at rest and on movement as secondary outcomes. Data was pooled using random effect models and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs).
resultsData from a total of 741 patients in 10 randomised controlled trials (RCTs) from 1993 to 2023 were included. Nine trials were open surgery, and one trial was laparoscopic. Relative to intravenous opioids, TEA significantly reduced a composite of PPCs (risk ratio (RR) 3.88; 95% confidence interval (CI) 1.98-7.61; n = 222; 3 RCTs) and pain scores (0-100-mm visual analogue scale or VAS) at rest at 24 h (MD 9.02; 95% CI 5.88-12.17; n = 685; 10 RCTs) and 48 h (MD 8.64; 95% CI 5.91-11.37; n = 685; 10 RCTs) and pain scores on movement at 24 h (MD 14.96; 95% CI 5.46-24.46; n = 275; 4 RCTs) and 48 h (MD 16.60; 95% CI 8.72-24.47; n = 275; 4 RCTs).
conclusionsRecent trials of analgesic technique in oesophagectomy surgery are restricted by small sample size and variation of outcome measurement. Despite these limitations, current evidence indicates that thoracic epidural analgesia reduces the risk of PPCs and severe pain, compared to intravenous opioids in patients following oesophageal cancer surgery. Future research should include minimally invasive surgery, non-epidural regional techniques and record morbidity, using core outcome measures with standardised endpoints.
trial registrationProspectively registered on PROSPERO (CRD42023484720).
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