The majority of evidence favors an ability of epidural analgesia to reduce postoperative cardiovascular and pulmonary complications only after major vascular surgery or in high-risk patients .
This finding may become irrelevant because of rapid conversion of major surgery to minimally invasive techniques ( e.g. , endoluminal abdominal aortic repair ) that carry less risk of complications .
There is also consistent evidence that epidural analgesia with local anesthetics is associated with faster resolution of postoperative ileus after major abdominal surgery .
Again , this finding may also become irrelevant with the adoption of laparoscopic techniques and multimodal fast-track programs for abdominal surgery .
There is no current evidence that perineural analgesia , continuous wound catheters using local anesthetics , IV patient-controlled analgesia with opioids , or addition of multimodal systemic analgesics have any clinical ly significant beneficial effect on postoperative complications .
CONCLUSIONS : Overall , there is insufficient evidence to confirm or deny the ability of postoperative analgesic techniques to affect major postoperative mortality or morbidity .
This is primarily due to typically insufficient subject numbers to detect differences in currently low incidences of postoperative complications
BACKGROUND : Few individual clinical trials have had sufficient subject numbers to definitively determine the effects of postoperative analgesia on major outcomes .
Epidural analgesia with local anesthetics has the greatest theoretical potential to affect major outcomes and has been the most thoroughly investigated technique .
Preoperative Cardiac Events in Elderly Patients with Hip Fracture Randomized to Epidural or Conventional Analgesia
Background Perioperative myocardial ischemia occurs in 35 % of unselected elderly patients undergoing hip fracture surgery .  Perioperative epidural analgesia may reduce the incidence of adverse cardiac events . Methods The effect of early administration of epidural analgesia during the stressful presurgical period , on preoperative cardiac events was evaluated in a prospect i ve r and omized study in 68 patients with hip fractures who either had known coronary artery disease or were at high risk for coronary artery disease . On admission to the emergency room , patients were assigned to receive a usual care analgesic regimen ( intramuscular meperidine , control group , n = 34 ) or continuous epidural infusion of local anesthetic and opioid ( epidural group , n = 34 ) . Monitoring in the preoperative period included a preoperative history and physical examination , daily assessment of cardiac adverse events , serial electrocardiograms , cardiac enzymes , and pain scores . Results Preoperative adverse cardiac events were significantly more prevalent in the control group compared with the epidural group ( 7 of 34 vs. 0 of 34;P = 0.01 ) . Adverse cardiac events included fatal myocardial infa rct ion in three , fatal congestive heart failure in one , nonfatal congestive heart failure in one , and new onset atrial fibrillation in two . The incidence of intraoperative and postoperative adverse cardiac events was similar for the two groups . The significant difference between groups in the incidence of preoperative cardiac events prompted interruption of the study after the planned interim analysis . Conclusions The authors ’ data indicate that compared with conventional analgesia , early administration of continuous epidural analgesia is associated with a lower incidence of preoperative adverse cardiac events in elderly patients with hip fracture who have or are at risk for coronary artery disease . Preoperative epidural analgesia may be advantageous for this surgical population
The majority of evidence favors an ability of epidural analgesia to reduce postoperative cardiovascular and pulmonary complications only after major vascular surgery or in high-risk patients .
This finding may become irrelevant because of rapid conversion of major surgery to minimally invasive techniques ( e.g. , endoluminal abdominal aortic repair ) that carry less risk of complications .
There is also consistent evidence that epidural analgesia with local anesthetics is associated with faster resolution of postoperative ileus after major abdominal surgery .
Again , this finding may also become irrelevant with the adoption of laparoscopic techniques and multimodal fast-track programs for abdominal surgery .
There is no current evidence that perineural analgesia , continuous wound catheters using local anesthetics , IV patient-controlled analgesia with opioids , or addition of multimodal systemic analgesics have any clinical ly significant beneficial effect on postoperative complications .
CONCLUSIONS : Overall , there is insufficient evidence to confirm or deny the ability of postoperative analgesic techniques to affect major postoperative mortality or morbidity .
This is primarily due to typically insufficient subject numbers to detect differences in currently low incidences of postoperative complications
BACKGROUND : Few individual clinical trials have had sufficient subject numbers to definitively determine the effects of postoperative analgesia on major outcomes .
Epidural analgesia with local anesthetics has the greatest theoretical potential to affect major outcomes and has been the most thoroughly investigated technique .