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 Thoracic Epidural Analgesia with Bupivacaine 0.25% on Ventilatory Mechanics in Patients with Severe Chronic Obstructive Pulmonary Disease
Optimal analgesia is important after thoracotomy in pulmonary-limited patients to avoid pain-related pulmonary complications . Thoracic epidural anesthesia ( TEA ) can provide excellent pain relief . However , potential paralysis of respiratory muscles and changes in bronchial tone might be unfavorable in patients with end-stage chronic obstructive pulmonary disease ( COPD ) . Therefore , we evaluated the effect of TEA on maximal inspiratory pressure , pattern of breathing , ventilatory mechanics , and gas exchange in 12 end-stage COPD patients .  Pulmonary resistance , work of breathing , dynamic intrinsic positive end-expiratory pressure , and peak inspiratory and expiratory flow rates were evaluated by assessing esophageal pressure and airflow . An increase in minute ventilation ( 7.50 ± 2.60 vs 8.70 ± 2.10 L/min;P = 0.04 ) by means of increased tidal volume ( 0.46 ± 0.16 vs 0.53 ± 0.14 L/breath;P = 0.003 ) was detected after TEA . These changes were accompanied by an increase in peak inspiratory flow rate ( 0.48 ± 0.17 vs 0.55 ± 0.14 L/s;P = 0.02 ) and a decrease in pulmonary resistance ( 20.7 ± 9.9 vs 16.6 ± 8.1 cm H2O · L−1 · s−1;P = 0.02 ) . Peak expiratory flow rate , dynamic intrinsic positive end-expiratory pressure , work of breathing , Pao2 , and maximal inspiratory pressure were unchanged ( all P > 0.50 ) . We conclude that TEA with bupivacaine 0.25 % can be used safely in end-stage COPD patients
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 .