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 .
Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease
Background —In patients with ischemic heart disease , high thoracic epidural analgesia ( TEA ) has been proposed to improve abnormalities of coronary function by inhibiting cardiac sympathetic tone . We evaluated the effect of TEA on myocardial blood flow in patients with ischemic heart disease . Methods and Results —Twenty male patients with multivessel ischemic heart disease were studied . An epidural catheter was inserted between the second and third thoracic vertebral interspace ( Th2 to Th3 ) . Analgesia was induced by epidural injection of bupivacaine 0.5 % , and a sensory block from the sixth cervical ( C6 to C7 ) to Th10 ( Th8 to Th11 ) vertebral interspace was achieved . Myocardial blood flow was measured with dynamic 13N-ammonia PET with and without TEA at rest , during pharmacological vasodilation with dipyridamole , and during sympathetic stimulation with the cold pressor test . Myocardial blood flow during dipyridamole increased similarly , regardless of TEA , in all regions except in myocardium subtended by collateral arteries in which blood flow increased more with than without TEA ( P<0.05 ) . Without TEA , myocardial blood flow during the cold pressor test remained unchanged compared with myocardial blood flow at rest . In contrast , with TEA , myocardial blood flow increased in all vascular territories . Coronary vascular resistance increased during the cold pressor test without TEA , whereas with TEA , coronary resistance decreased in myocardium subtended by nonstenotic and stenotic coronary vessels and remained unchanged in myocardium subtended by occluded vessels . Conclusions —In patients with multivessel ischemic heart disease , TEA partly normalizes the myocardial blood flow response to sympathetic stimulation
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 .