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 Following Surgery in Medicare Patients
Background Because of the uncertainty and limitations in available r and omized controlled trials , we performed an analysis of the Medicare cl aims data base to determine whether an association exists between postoperative epidural analgesia and mortality . Methods A 5 % nationally r and om sample of Medicare beneficiaries from 1997 to 2001 was analyzed to identify patients undergoing segmental excision of the lung ( International Statistical Classification of Diseases , Ninth Revision , Clinical Modification codes 32.3 and 32.4 ) , complete pneumonectomy ( code 32.5 ) , partial excision of large intestine ( codes 45.73 and 45.76 ) , anastomosis of the esophagus ( codes 42.5 and 42.6 ) , total knee replacement/revision ( codes 81.54 and 81.55 ) , total/radical abdominal hysterectomy ( codes 68.4 and 68.6 ) , partial/radical pancreaticoduodenectomy ( codes 52.5 and 52.7 ) , partial/complete nephrectomy ( codes 55.4 and 55.5 ) , partial/complete cystectomy ( codes 57.6 and 57.7 ) , hepatotomy/lobectomy of the liver ( codes 50.0 and 50.3 ) , partial/total gastrectomy ( codes 43.5 to 43.9 ) , and radical retropubic prostatectomy ( codes 60.4 and 60.5 ) . Patients were divided into 2 groups , depending on the presence or absence of postoperative epidural analgesia . The rate of major morbidity and death at 7 and 30 days after surgery were compared . Multivariate regression analyses incorporating race , gender , age , comorbidities , hospital size , hospital teaching status , and hospital technology status were performed . Results The presence of epidural analgesia was associated with a significantly lower odds of death at 7 days ( odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.38 to 0.73 ; P = .0001 ) and 30 days ( OR , 0.74 ; 95 % CI , 0.63 to 0.89 ; P = .0005 ) after surgery ; however , no difference was seen between the groups with regard to overall major morbidity , with the exception of an increase in pneumonia at 30 days for the epidural group ( OR , 1.91;[95 % CI , 1.09 to 3.34 ; P = .02 ) . Conclusions Postoperative epidural analgesia may contribute to lower odds of death after surgery
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 .