Abstract
Many of the benefits of effective epidural analgesia for open abdominal surgery are soundly established. A well-managed epidural can provide excellent analgesia in the postoperative period allowing the patient to be pain free at rest and when mobilizing. In addition, epidural block will obtund the acute stress response to surgery. Consequently along with the analgesic benefits, patients are less likely to suffer cardiac, respiratory, or gastrointestinal side-effects. However, the increasing application of laparoscopic techniques for many major intra-abdominal procedures results in less pain and shorter recovery times than open surgery. We now have a clearer appreciation of the potential risks of epidural analgesia. A number of alternative local anaestheticbased analgesic techniques have been described. In the context of these advances, we discuss whether in fact in abdominal surgery, there is still a time and a place for the thoracic epidural?
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