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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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PERIOPERATIVE MEDICINE  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 April;68(4):157-61

language: English

Effect of postoperative epidural analgesia on surgical outcome

Holte K., Kehlet H.

From the Department of Surgical Gastroenterology Hvidovre University Hospital, Denmark


­­Pain ­relief allow­ing suf­fi­cient mobil­iza­tion ­after ­major sur­gi­cal pro­ce­dures can ­only be ­achieved by con­tin­u­ous epi­du­ral anal­ge­sia ­with ­local anes­thet­ics, ­which ­also reduc­es the ­stress ­response to sur­gery. How­ev­er, the ­role of post­op­er­a­tive epi­du­ral anal­ge­sia on post­op­er­a­tive mor­bid­ity is con­tro­ver­sial. We there­fore ­update the ­effects of post­op­er­a­tive anal­ge­sia on sur­gi­cal out­come. ­After ­major abdom­i­nal sur­gery, post­op­er­a­tive epi­du­ral anal­ge­sia ­with ­local anes­thet­ics sig­nif­i­cant­ly reduc­es post­op­er­a­tive ile­us and pul­mo­nary com­pli­ca­tions ­while ­effects on car­diac mor­bid­ity are debat­able. Con­tin­u­ous epi­du­ral anal­ge­sia sig­nif­i­cant­ly low­ers the ­risk of throm­boem­bol­ic com­pli­ca­tions ­after low­er ­body pro­ce­dures, ­while no ­effect is ­seen ­after ­major abdom­i­nal sur­gery. Unfor­tu­nate­ly, ­many stud­ies ­have inad­e­quate ­study ­design, ­with use of lum­bar epi­du­ral anal­ge­sia for abdom­i­nal pro­ce­dures, or the epi­du­ral reg­i­men ­does not con­tain a suf­fi­cient ­amount of ­local anes­thet­ics. ­Future eval­u­a­tion of the ­effects of epi­du­ral anal­ge­sia on post­op­er­a­tive out­come ­also ­requires inte­gra­tion of epi­du­ral anal­ge­sia with­in a mul­ti­mod­al reha­bil­i­ta­tion pro­gramme.

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