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 .
Improvement of 'dynamic analgesia' does not decrease atelectasis after thoracotomy.
There is still controversy concerning the beneficial aspects of ' dynamic analgesia ' ( i.e. pain while coughing or moving ) on the reduction of postoperative atelectasis . In this study , we tested the hypothesis that thoracic epidural analgesia ( TEA ) prevents these abnormalities as opposed to multimodal analgesia with i.v . patient controlled analgesia ( i.v . PCA ) after thoracotomy . Fifty-four patients undergoing thoracotomy ( lung cancer ) were r and omly assigned to one of the two groups . Clinical respiratory characteristics , arterial blood gas , and pulmonary function tests ( forced vital capacity and forced expiratory volume in 1 s ) were obtained before surgery and on the next 3 postoperative days . Atelectasis was compared between the two groups by performing computed tomography ( CT ) scan of the chest at day 3 . Postoperative respiratory function and arterial blood gas values were reduced compared with preoperative values ( mean ( SD ) FEV1 day 0 : 1.1 ( 0.3 ) litre ; 1.3 ( 0.4 ) litre ) but there was no significant difference between groups at any time . PCA and TEA provided a good level of analgesia at rest ( VAS day 0 : 21 ( 15/100 ) ; 8 ( 9/100 ) ) , but TEA was more effective for analgesia during mobilization ( VAS day 0 : 52 ( 3/100 ) ; 25 ( 17/100 ) ) . CT scans revealed comparable amounts of atelectasis ( expressed as a percentage of total lung volume ) in the TEA ( 7.1 (2.8)% ) and in the i.v . PCA group ( 6.71 (3.2)% ) . There was no statistical difference in the number of patients presenting with at least one atelectasis of various types ( lamellar , plate , segmental , lobar )
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 .