Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence.

摘要: BACKGROUND: Few individual clinical trials have had sufficient subject numbers to definitively determine the effects of postoperative analgesia on major outcomes. METHODS: We systematically searched Medline and Cochrane Library databases for past decade focused meta-analyses large, randomized, controlled trials. RESULTS: Eighteen meta-analyses, 10 systematic reviews, 8 additional trials, 2 observational database articles were identified review or comment. Epidural with local anesthetics has greatest theoretical potential affect outcomes been most thoroughly investigated technique. The majority evidence favors an ability epidural reduce cardiovascular pulmonary complications only after vascular surgery in high-risk patients. This finding may become irrelevant because rapid conversion minimally invasive techniques (e.g., endoluminal abdominal aortic repair) that carry less risk complications. There is also consistent associated faster resolution ileus surgery. Again, this adoption laparoscopic multimodal fast-track programs no current perineural analgesia, continuous wound catheters using anesthetics, IV patient-controlled opioids, addition systemic analgesics any clinically significant beneficial effect CONCLUSIONS: Overall, there insufficient confirm deny analgesic mortality morbidity. primarily due typically detect differences currently low incidences