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 .
The Effects of Continuous Epidural Anesthesia and Analgesia on Stress Response and Immune Function in Patients Undergoing Radical Esophagectomy
We investigated whether perioperative extensive epidural block ( C3-L ) affects postoperative immune response in patients undergoing radical esophagectomy . Patients undergoing radical esophagectomy were r and omly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia ( group E , n = 15 ) or intraoperative general anesthesia and postoperative IV morphine analgesia ( group G , n = 15 ) . Plasma levels of stress hormones , cytokines , C-reactive protein ( CRP ) , leukocyte counts , and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days ( PODs ) 1 and 3 . In comparison with group E , significant increases in plasma epinephrine level at the end of surgery ( P < 0.05 ) and norepinephrine level at the end of surgery ( P < 0.01 ) and on POD1 ( P < 0.01 ) and POD3 ( P < 0.01 ) and significant decrease in cluster of differentiation ( CD4/CD8 ratio ) at the end of surgery ( P < 0.05 ) were observed in group G. However , there were no significant differences in other variables between groups . In both groups , plasma cortisol , adrenocorticotropic hormone , interleukin (IL)-1β , IL-6 , IL-10 , and CRP levels were increased after surgery ( each group P < 0.01 ) and IL-1β , IL-6 , IL-10 , and CRP were still increased on POD1 and POD3 ( each change , each group P < 0.01 ) . Leukocyte counts were increased on POD1 ( each group P < 0.05 ) and POD3 ( each group P < 0.01 ) . The proportion of lymphocytes decreased from the end of surgery to POD3 ( each group P < 0.01 ) . The proportion of B cells was increased on POD1 ( each group P < 0.01 ) ; that of natural killer cells was decreased at POD1 and POD3 ( each group P < 0.01 ) . We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy
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 .