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 .
Postoperative Wound Oxygen Tension with Epidural or Intravenous Analgesia: A Prospective, Randomized, Single-blind Clinical Trial
Background Adequate tissue oxygen tension is an essential requirement for surgical-wound healing . The authors tested the hypothesis that epidural anesthesia and analgesia increases wound tissue oxygen tension compared with intravenous morphine analgesia . Methods In a prospect i ve , r and omized , blind clinical study , the authors allocated patients having major abdominal surgery ( n = 32 ) to receive combined general and epidural anesthesia with postoperative patient-controlled epidural analgesia ( epidural group , n = 16 ) , or general anesthesia alone with postoperative patient-controlled intravenous analgesia ( intravenous group , n = 16 ) . An oxygen sensor and a temperature sensor were placed subcutaneously in the wound before closure . Wound oxygen tension ( Pwo2 ) and temperature were measured continuously for 24 h. Other variables affecting wound tissue oxygenation and visual analogue scale ( VAS ) pain scores were also documented . Results Despite epidural patients having lower body temperatures at the end of surgery ( 35.7 ± 0.3 ) versus 36.3 ± 0.5 ° C , P = 0.004 ) , they had significantly higher mean Pwo2 over the 24 h period , compared with the intravenous group ( 64.4 ± 14 vs. 50.7 ± 15 ) mmHg , mean ( SD ) , 95 % CI difference , −22 to −5 , P = 0.002 ) . Area under the Pwo2 −24 h time curve was also significantly higher in the epidural group ( 930 ± 278 vs. 749 ± 257 ) mmHg × h , 95 % CI difference −344 to −18 , P = 0.03 ) . VAS pain scores at rest and moving were significantly lower in the epidural group at all times . Conclusion Epidural anesthesia and postoperative analgesia for major abdominal surgery increases wound tissue oxygen tension compared with general anesthesia and intravenous morphine analgesia
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 .