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Materials and Methods: A Literature search was done including the following databases: Medline via PubMed, EMBASE and the Cochrane database from 1980 until November 2009. The search strategy included the following key words: pain, postoperative, catheters and local anaesthetics in all possible permutations and combinations. Two co-authors (SF and AP) independently read every article that was initially included and extracted data according to a pre- defined study record form. When discrepancy was seen in the extracted data, the senior author (AG) resolved this through discussion. Data was then entered into a statistical programme for meta-analysis, Revman version 5.0 and analysed.
Results and Discussion: A total of 813 studies fitted our search criteria of which 170 were related to general and thoracic surgery. Of these, only 47 studies could be included in the analysis, and only 29 studies had some VAS/NRS data presented in a way that could be included in a statistical analysis. A significant heterogeneity was found between the studies and I2 (a measure of heterogeneity) was > 50% in most parameters and > 75% in many suggesting that these studies may not be homogenous and even vary largely in the assessment of a common end-point. Data was often difficult to extract and therefore the meta-analysis excluded a sizeable number of studies. Significant but mild analgesia was found (∽ 1 cm difference in VAS/NRS) in the treatment group at most time periods and morphine consumption was lower in those studies that could be included in the meta-analyses.
Conclusion(s): Although the technique of LA administration via catheters is simple in its application, this meta-analysis was characterized by marked heterogeneity between studies suggesting that it is difficult (if not impossible) to pool these studies together. Furthermore, a substantial number of studies could not be included in the meta-analysis due to the absence of relevant data, thus questioning the results of such an analysis. Finally, the small differences seen between the treatment and control groups in those studies that could be analysed quantitatively may be more of academic rather than clinical significance in the individual patient.
