Postoperative epidural analgesia: is it worth the effort?

Abstract

Does epidural analgesia offer us anything that we cannot accomplish with parenteral opioids? Specifically, do epidural opioids, with or without local anaesthetics, provide superior analgesia, contribute to reduced morbidity, or reduce the cost of hospitalization? For patients undergoing thoracic, major abdominal, or vascular surgery the answer appears to be yes. Epidural morphine, and probprobably thoracic epidural fentanyl, can provide analgesia superior to that obtained withiv-PCA but the role of epidural opioid local anaesthetic combinations is still unclear. In patients undergoing major vascular surgery, and in those patients scheduled preoperatively for postoperative ICU admission, there is some good evidence that postoperative morbidity is reduced. Finally, there is limited evidence that for patients undergoing major abdominal or thoracic surgery, the cost of hospitalization is reduced, but this important area of research is in its infancy.