Summary of findings for the main comparison. Epidural local anaesthetic compared with opioid‐based regimen for adults.
| Epidural local anaesthetic compared with opioid‐based regimen for adults | ||||||
| Patient or population: adults Settings: Trials were performed in Australia (n = 4); Canada (n = 19); China (n = 6); Czech Republic (n = 1); Denmark (n = 8); Egypt (n = 3); Finland (n = 4); France (n = 5); Germany (n = 10); Greece (n = 2); India (n = 3); Israel (n = 2); Italy (n = 10); Japan (n = 1); Korea (n = 1); Lithuania (n = 1); Romania (n = 2); Russia (n = 1); Serbia (n = 1); Spain (n = 1); Sweden (n = 6); Switzerland (n = 2); The Netherlands (n = 1); Turkey (n = 8); United Kingdom (n = 6); United States of America (n = 17); and Uruguay (n = 1) Intervention: epidural local anaesthetic Comparison: opioid‐based regimen | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Opioid‐based regimen | Epidural local anaesthetic | |||||
| Time required to observe first flatus | Mean time required to observe first flatus in the intervention groups was 1.28 standard deviations lower (1.71 to 0.86 lower) | 1138 (22 studies) | ⊕⊕⊕⊕ higha,b,c,d,e,f,g,h | Effect size was proportionate to the concentration of local anaesthetic used Pooled reduction is equivalent to 17.5 hours | ||
| Time required to observe first faeces | Mean time required to observe first faeces in the intervention groups was 0.67 standard deviations lower (0.86 to 0.47 lower) | 1559 (28 studies) | ⊕⊕⊝⊝ lowc,d,e,g,i,j,k,l | Pooled reduction is equivalent to 22 hours | ||
| VAS scores on movement at 24 hours | Mean VAS scores on movement at 24 hours in the intervention groups was 0.85 standard deviations lower (1.04 to 0.67 lower) | 2731 (35 studies) | ⊕⊕⊕⊝ moderatea,b,c,d,e,f,g,l | Pooled reduction is equivalent to 2.5 on a scale from 0 to 10 | ||
| Vomiting during first 24 hours | Study population | RR 0.84 (0.57 to 1.23) | 1154 (22 studies) | ⊕⊕⊝⊝ lowc,e,g,i,k,l,m,n | ||
| 170 per 1000 | 143 per 1000 (97 to 210) | |||||
| Low | ||||||
| 50 per 1000 | 42 per 1000 (28 to 62) | |||||
| High | ||||||
| 250 per 1000 | 210 per 1000 (142 to 308) | |||||
| Anastomotic leak | Study population | RR 0.74 (0.41 to 1.32) | 848 (17 studies) | ⊕⊕⊝⊝ lowc,e,g,i,k,l,m,n | ||
| 53 per 1000 | 39 per 1000 (22 to 70) | |||||
| Low | ||||||
| 30 per 1000 | 22 per 1000 (12 to 40) | |||||
| High | ||||||
| 100 per 1000 | 74 per 1000 (41 to 132) | |||||
| Length of hospital stay | Mean length of hospital stay in the intervention groups was 0.20 standard deviations lower (0.35 to 0.04 lower) | 2598 (30 studies) | ⊕⊝⊝⊝ very lowa,c,d,j,k,l,o,p | Pooled reduction is equivalent to 1 day | ||
| The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate | ||||||
aAllocation concealment and/or blinding of outcome assessors rated as unclear or high risk for 75% or more of included studies for this outcome bWe did not downgrade the quality of evidence on the basis of inconsistency because a reasonable explanation was found for heterogeneity cDirect comparisons performed on the population of interest and not a surrogate marker dOptimal information size achieved eNo evidence of a publication bias, or applying a correction for the possibility of publication bias would not modify the conclusion fLarge effect size (SMD≥ 0.8) gNo evidence of confounding factors to justify upgrading hEffect size was proportionate to the local anaesthetic concentration i50% or more of included studies were rated as unclear or high risk for allocation concealment and/or blinding of outcome assessors jWe downgraded the level of evidence on inconsistency owing to a moderate amount of heterogeneity kNo evidence of a large effect lNo evidence of a dose‐response effect mNo heterogeneity or heterogeneity less than 25% nOptimal information size not achieved oCorrecting for the possibility of publication bias would modify the conclusion pLength of hospital stay may not adequately reflect readiness for discharge, as actual discharge may be delayed for various reasons