Randomized studies, published in English between 1995 and 2011, assessing analgesic and anaesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases.
Dr Joshi and colleagues assessed the efficacy and adverse effects of the analgesic techniques.
The recommendations were based on procedure-specific evidence from a systematic review and supplementary transferable evidence from other relevant procedures.
Of the 170 randomized studies identified, 12 studies were included.
The research team found that overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine and epidural analgesia improved pain relief, reduced opioid requirements and improved bowel function.
|12 studies were included|
The team of doctors noted that there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis.
The L’Abbé plots of the data from the epidural analgesia studies included in this review indicate that the pain scores in the nonepidural groups, although higher than those in the epidural groups, were within an acceptable level.
Dr Joshi's team concluded, "Infiltration of surgical incisions with local anaesthetic at the end of surgery, systemic steroids, conventional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors in combination with paracetamol with opioid used as rescue are recommended."
"Intravenous lidocaine infusion is recommended, but not as the first line of therapy."
"However, neuraxial blocks are not necessary based on high risk:benefit ratio."