Eight studies were included in the review (n=331 patients), comprising six RCTs, one observational study that was a sub-group of another RCT and one consecutive-matched cohort study. Two RCTs were given a Jadad score of 1 point, one RCT scored of 3 points, one RCT scored 4 points, and two RCTs plus the observational study scored of 5 points.
Epidural or intravenously-administered analgesia versus patient-controlled analgesia: Three RCTs and one observational study found no significant differences in length of hospital stay between the two treatment groups. One RCT found a reduction in time to tolerance of a normal diet, a reduced time to flatus, a reduced time to bowel opening and lower pain scores in the epidural group. In another RCT, pain scores were lower in the epidural group compared with the patient-controlled analgesia group. The observational study found that there was a significantly shorter time to bowel opening in the epidural group than in the patient-controlled analgesia group.
Epidural versus intravenous analgesia: The cohort study found that there was a significant difference in hospital stay (shorter stay) in the epidural ropivacaine group.
Intravenous analgesia versus placebo: One RCT (n=40 patients) showed reduced length of hospital stay, reduced time to flatus, reduced time to bowel opening, and lower pain scores for the intravenous lidocaine-treated group. One RCT (n=44 patients) showed that the use of intravenous ketorolac was associated with a significantly reduced time for tolerance of a normal diet, time to flatus, and lower pain scores compared with placebo; the incidence of anastomotic leakage was higher in the ketorolac group than the placebo group, but there were no differences in the admission rates between the groups.
There were no differences between treatments for nausea and vomiting, readmission rates, urinary retention, or hypotension.