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Validity Tian et al.

(2015)
What question Yes, the
(PICO) did the question is
systematic review clearly stated in
address? the title, and
introduction
Is it unlikely that Yes, in the
important, relevant method section
studies were it is stated that
missed? the writers
searched RCTs
on major
database with
no language
restriction.
Were the criteria Yes, the
used to select inclusion
articles for criteria are
inclusion stated in the
appropriate? method section.
The type of
study design is
also stated
Were the included Yes, the article
studies sufficiently describe the
valid for the type quality of each
of question asked? study including
randomization,
blinding, bias,
etc
Were the results Yes, the results
similar from study from different
to study? studies are
homogenous,
especially the
data on the first
post-operative’s
VAS.
Conclusion Valid
For the importance of this meta-analysis, we can see the heterogeneity of the study. The main
outcome of this meta-analysis is to analyze the post-operative visual analogue scores (VAS)
between the use of PCEA and PCIA in patients. The VAS scores were grouped into the first
post-operative day, second postoperative day, and third postoperative day.
On the first postoperative day, there was no significant heterogeneity with Chi2=3.54, dF=6,
I2=0%, and P=0.72. On the forest plot we can see that the pooled result favors PCEA, there’s
a statistically significant difference between PCEA and PCIA with P=0.0005 and CI -0.74 to -
0.2. But clinically the VAS difference are not that significant, since the mean difference in is -
0,47.
The result for VAS score at second day postoperative show no significant heterogeneity with
Chi2=6,47, dF=4, I2=38%, and P=0.17. The pooled result favors PCEA, and there’s a
significant difference between PCEA and PCIA with P=0,006, and CI -1.14 to -0.19. However
clinically the mean difference is very small (-0,66), which is clinically insignificant.
VAS score on third postoperative day shows substantial heterogeneity, with Chi2=10.24, dF=4,
I2=61%, and P=0.04. The pooled result favors PCEA, but there’s no significant difference
statistically and clinically with the mean difference -0,58, I=1.38 to 0.21 and P=0.15.
So to conclude the result of this meta-analysis, PCEA and PCIE have a similar efficacy in
reducing post-operative pain.
Applicability Tian et al.
(2015)
Is my patient so No, although the
different to those surgery type is
in the study that different (the
the results patient in the
cannot apply? case illustration
undergo
abdominal
surgery, and the
patient in this
study undergo
spinal fusion
surgery), the
demographic
characteristic
between the two
patients are
similar
Is the treatment Yes, PCEA is
feasible in my feasible to be
setting? done in RSCM.
The drugs used
in this study are
also available in
RSCM
Will the No, the VAS
potential differences
benefits of between PCEA
treatment and PCIA in the
outweigh the first 2 days post-
potential harms operative is
of treatment for statistically
my patient? significant, but it
is not clinically
it is not
substantial. But
PCEA cause
higher incidence
of pruritus and
paresthesia than
PCIA.
Conclusion Not Applicable