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 .
Perioperative Intravenous Lidocaine Has Preventive Effects on Postoperative Pain and Morphine Consumption After Major Abdominal Surgery
Sodium channel blockers are approved for IV administration in the treatment of neuropathic pain states . Pre clinical studies have suggested antihyperalgesic effects on the peripheral and central nervous system . Our objective in this study was to determine the time course of the analgesic and antihyperalgesic mechanisms of perioperative lidocaine administration . Forty patients undergoing major abdominal surgery participated in this r and omized and double-blinded study . Twenty patients received lidocaine 2 % ( bolus injection of 1.5 mg/kg in 10 min followed by an IV infusion of 1.5 mg · kg−1 · h−1 ) , and 20 patients received saline placebo . The infusion started 30 min before skin incision and was stopped 1 h after the end of surgery . Lidocaine blood concentrations were measured . Postoperative pain ratings ( numeric rating scale of 0–10 ) and morphine consumption ( patient-controlled analgesia ) were assessed up to 72 h after surgery . Mean lidocaine levels during surgery were 1.9 ± 0.7 & mgr;g/mL. Patient-controlled analgesia with morphine produced good postoperative analgesia ( numeric rating scale at rest , ≤3 ; 90%–95 % ; no group differences ) . Patients who received lidocaine  reported less pain during movement and needed less morphine during the first 72 h after surgery ( 103.1 ± 72.0 mg versus 159.0 ± 73.3 mg ; Student ’s t-test ; P < 0.05 ) . Because this opioid-sparing effect was most pronounced on the third postoperative day , IV lidocaine may have a true preventive analgesic activity , most likely by preventing the induction of central hyperalgesia in a clinical ly relevant manner
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 .