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 .
Effect of Postoperative Epidural Analgesia on Morbidity and Mortality After Total Hip Replacement Surgery in Medicare Patients
Background and Objectives : The effect of postoperative epidural analgesia ( vs. systemic analgesia ) on patient outcomes is unclear . Available r and omized controlled trials ( RCTs ) have focused on the intraoperative period and not properly examined the effect of postoperative epidural analgesia ( EA ) on outcomes . Methods : A 5 % nationally r and om sample of Medicare beneficiaries from 1994 to 1999 was analyzed to identify patients undergoing total hip arthroplasty ( Common Procedural Terminology [ CPT ] code 27130 , 27132 , 27134 , 27137 , 27138 ) . Patients were divided into 2 groups depending on the presence or absence of postoperative EA based on the CPT coding ( 01996 ) . The rate of major morbidity ( acute myocardial infa rct ion , deep venous thrombosis , pulmonary embolism , angina , respiratory failure , heart failure , cardiac dysrhythmias , pneumonia , pulmonary edema , sepsis , acute renal failure , paralytic ileus , acute cerebrovascular event ) and death at 7 and 30 days after the procedure were compared . Multivariate regression analysis was performed to determine if the presence of postoperative ( EA ) had an independent effect on mortality or major morbidity . Data were reported as an odds ratio with 95 % confidence intervals ( CI ) when appropriate . Results : The unadjusted 7‐ and 30‐day death rate was significantly lower for EA versus no EA ( 1.9/1000 [ 95 % CI : 0.2‐3.6 ] vs. 3.9/1000 [ 95 % CI : 3.0‐6.2 ] at 7 days [ P = .04 ] and 5.8/1000 [ 95 % CI : 2.9‐8.7 ] vs. 9.9/1000 [ 95 % CI : 8.6‐11.3 ] at 30 days [ P = 0.01 ] ) . However , multivariate regression analysis revealed that there was no difference between the groups with regard to mortality or major morbidity with the exception of an increase in deep venous thrombosis in patients who received EA . Conclusions : The use of postoperative EA was not associated a lower incidence of mortality and major morbidity in Medicare patients undergoing total hip arthroplasty . However , the results should be interpreted with caution because of limitations in using the Medicare cl aims data for analysis . Further trials using other properly conducted and design ed studies ( e.g. , RCTs ) would be ideal to vali date these results
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 .