884 Optimising Analgesic Strategies in Patients Post-Oesphagectomy – a Systematic Review and Network Meta-Analysis of Randomised Clinical Trials

Abstract Aim To perform a systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs) evaluating the optimal analgesia strategy post-oesophagectomy. Method A Network Meta-Analysis was performed according to PRISMA-NMA guidelines. Statistical analysis using Shiny R. Results 14 RCTs which included 565 patients assessed 9 techniques were included. Relative systemic opioids (SO), thoracic epidural (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01−0.45) (n = 424, 12 RCTs). Intrapleural (IPA) demonstrated best efficacy for (MD: −36.2, CI: −61.44−10.96) 569, 15 RCTs) dynamic −42.90, −68.42−17.38) 444, 11 48 hours. TEA also −13.05, −22.74−3.36) −18.08, −31.70−4.40) post-operatively, as well reducing opioid consumption −33.20, −60.57−5.83) −42.66, −59.45−25.88). Moreover, shortened intensive care unit (ICU) stays −5.00, −6.82−3.18) time extubation −4.40, −5.91−2.89) while increased post-operative forced vital capacity 9.89, 0.91−18.87) expiratory volume 13.87, 0.87−26.87). Conclusions provides control improved post operative respiratory function in post-oesophagectomy, ICU stays, one benchmarks recovery.