Comparison of Wound Infusion Catheter Versus Epidural Catheter for Analgesia After Midline Incision for Major Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Background To evaluate comparative outcomes of wound infusion catheter (WC) vs epidural analgesia (EP) for analgesia following midline laparotomy for abdominal surgery. Methods A systematic search of PubMed, Cochrane Library, and Scopus was conducted, and all randomised controlled trials (RCTs) comparing WC vs EP for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and length of hospital stay (LOS) were set as outcome parameters for the meta-analysis. Subgroups of catheter positions, including preperitoneal, rectus sheath and transversus abdominis plane block as deep WC and subcutaneous WC, were examined for pain scores superiority. Results Twelve RCTs were pooled in a meta-analysis, involving a total of 778 patients who received WC (n = 390) or EP (n = 388). There was no significant difference in pain scores at rest and movement between WC and EP groups at 24 hours [ P = .85 and P = .30, respectively] and 48 hours [ P = .33 and P = .06, respectively]. However, subgroup analysis, excluding subcutaneous catheters, showed favourable pain scores on movement at 48 hours of use (mean difference [MD] −0.97, P = .03). The LOS was notably shorter in the WC group [MD, −0.50; P < .001]. There were no significant differences between both groups in cumulative morphine consumption [ P = .33], return of bowel function [ P = .13], respiratory depression [ P = .43], or catheter-related complications [ P = .16]. Conclusion WC generally provides a comparable postoperative analgesia to EP; however, it is associated with shorter LOS and a slight superiority of analgesia of deep catheters. Comparing different types of nerve blocks and positions of catheters in future research may optimise the use of WC.