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 .
Intravenous Lidocaine Speeds the Return of Bowel Function, Decreases Postoperative Pain, and Shortens Hospital Stay in Patients Undergoing Radical Retropubic Prostatectomy
Postoperative ileus is a concern among surgical patients .Epidural anesthesia and analgesia with local anesthetics can decrease the duration of ileus . Significant systemic absorption of local anesthesia occurs during epidural use . In this study , we examined whether many of the beneficial effects on bowel function seen with epidural lidocaine are also present when the drug is given parenterally . Forty patients undergoing radical retropubic prostatectomy were studied with one half of the patients receiving a lidocaine bolus ( 1.5 mg/kg ) and infusion ( 3 mg/min , unless weight < 70 kg , then 2 mg/min ) ; the other half received a saline infusion . A blind observer recorded the patient 's daily pain score , the time the patient first experienced flatulence and had the first bowel movement , and the total use of analgesics .  Lidocaine-treated patients first experienced flatulence in a significantly shorter time ( P < 0.01 ) than control patients . Lidocaine patients ' hospital stay was also significantly shorter ( P < 0.05 ) ; on average , they spent 1.1 fewer days in the hospital . IV lidocaine initiated before anesthesia and continued 1 h postoperatively significantly sped up the return of bowel function .  Lidocaine patients were also more comfortable postoperatively . Many of the bowel function benefits attributed to epidural lidocaine are also present when the drug is administered parenterally . Additionally , the length of hospital stay was reduced in lidocaine-treated patients . Implication s : This study prospect ively examined whether IV lidocaine could affect the return of bowel function after radical prostate surgery .  Lidocaine-treated patients had shorter hospital stays , less pain , and faster return of bowel function . In this population , lidocaine infusion can be a useful adjunct in anesthetic management . ( Anesth Analg 1998;86:235 - 9
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 .