Safety and efficacy of postoperative epidural analgesia

Abstract

Effective analgesia for postoperative pain relief after major surgery has been a practical proposition with epidural administration of local anaesthetic (LA) and opioid drugs since the early 1980s. Although epidural administration is perceived by 80% of UK anaesthetists as the ideal analgesic technique for upper abdominal surgery, 34 there are many patients undergoing major surgery who do not receive this form of analgesia. In a recent survey of UK practice, only 15% of patients undergoing abdominal surgery had epidural analgesia in the 12 hospitals sampled. 31 The main factor which has limited the use of epidural analgesia has been the difficulty in making a reasonable risk/benefit analysis about the technique, which has resulted in clinicians constantly asking whether epidurals are effective for postoperative pain relief and whether the technique is safe. This review considers the efficacy and safety of epidural analgesia in patients recovering from major surgery and is based on a computerized search of the literature from 1976 to 2000 (EMBASE/Medline). The final section will deal with the organizational issues which need to be considered to maximize efficacy and safety and is based on the authors’ joint experience of supervising acute pain services (APS) in New Zealand and the UK; these services have been responsible for pain relief in over 20 000 patients nursed on general postoperative wards.