Epidural Technique for Postoperative Pain
- 1 January 2012
- journal article
- review article
- Published by BMJ in Regional Anesthesia & Pain Medicine
- Vol. 37 (3), 310-317
- https://doi.org/10.1097/aap.0b013e31825735c6
Abstract
Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.Keywords
This publication has 74 references indexed in Scilit:
- Laparoscopy in Combination with Fast Track Multimodal Management is the Best Perioperative Strategy in Patients Undergoing Colonic SurgeryAnnals of Surgery, 2011
- Meta-analysis of Thoracic Epidural Anesthesia versus General Anesthesia for Cardiac SurgeryAnesthesiology, 2011
- Cancer Recurrence After SurgeryRegional Anesthesia & Pain Medicine, 2010
- Impact of Intravenous Lidocaine Infusion on Postoperative Analgesia and Recovery from SurgeryDrugs, 2010
- The anaesthetist and the environmentAnaesthesia, 2010
- Reduced hospital stay, morphine consumption, and pain intensity with local infiltration analgesia after unicompartmental knee arthroplastyActa Orthopaedica, 2009
- Epidural analgesia and post‐operative outcomes – a need for a different approachActa Anaesthesiologica Scandinavica, 2008
- A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplastyAnaesthesia, 2008
- Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer RecurrenceAnesthesiology, 2008
- Does Continuous Peripheral Nerve Block Provide Superior Pain Control to Opioids? A Meta-AnalysisAnesthesia & Analgesia, 2006