Impact of combined epidural anaesthesia/analgesia on postoperative cognitive impairment in patients receiving general anaesthesia: a meta-analysis of randomised controlled studies

doi:10.1016/j.accpm.2022.101119

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Title:	Impact of combined epidural anaesthesia/analgesia on postoperative cognitive impairment in patients receiving general anaesthesia: a meta-analysis of randomised controlled studies
Authors:	Teng, I-Chia Sun, Cheuk-Kwan Ho, Chun-Ning Wang, Li-Kai Lin, Yao-Tsung Chen, Ying-Jen Chin, Jen-Yin Chu, Chin-Chen Hsing, Chung-Hsi Hung, Kuo-Chuan
Contributors:	Chi Mei Hospital E-Da Hospital I Shou University Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy & Science
Keywords:	intraoperative hypotension risk-factors controlled analgesia elderly-patients delirium surgery dysfunction outcomes reduction
Date:	2022
Issue Date:	2023-12-11 13:56:18 (UTC+8)
Publisher:	ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER
Abstract:	Background: To investigate the efficacy of combined epidural anaesthesia/analgesia (EAA) against postoperative delirium/cognitive dysfunction (POD/POCD) in adults after major non-cardiac surgery under general anaesthesia (GA). Methods: The databases of PubMed, Google Scholar, Embase and Cochrane Central Register were searched from inception to November 2021 for available randomised controlled trials (RCTs) that assessed the impact of EAA on risk of POD/POCD. The primary outcome was risk of POD/POCD, while the secondary outcomes comprised postoperative pain score, length of hospital stay (LOS), risk of complications, and postoperative nausea/vomiting (PONV). Results: Meta-analysis of eight studies with a total of 2376 patients (EAA group: 1189 patients; non-EAA group: 1187 patients) revealed no difference in risk of POD/POCD between the EAA and the non-EAA groups [Risk ratio (RR): 0.68; 95% CI: 0.41 to 1.13, p = 0.14, I-2 = 73%], but the certainty of evidence was very low. Nevertheless, the EAA group had lower pain score at postoperative 24 h [mean difference (MD): -1.49, 95% CI: -2.38 to -0.61; I-2 = 98%; five RCTs; n = 476] and risk of PONV (RR = 0.73, 95% CI: 0.57 to 0.93, p = 0.01, I-2 = 0%; three RCTs, 1876 patients) than those in the non-EAA group. Our results showed no significant impact of EAA on the pain score at postoperative 36-72 h, LOS, and risk of complications. Conclusion: This meta-analysis demonstrated that EAA had no significant impact on the incidence of POD/POCD in patients following non-cardiac surgery. (c) 2022 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Relation:	Anaesthesia Critical Care & Pain Medicine, v.41, Issue 5, October 2022, 101119
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles [Dept. of Recreation and Health-Care Management] Periodical Articles

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