The role of epidural anesthesia and analgesia in surgical practice

Objective: To review the potential and proven benefits and complications of epidural anesthesia/analgesia. Summary Background Data: Advances in analgesia/anesthesia have improved patient satisfaction and perioperative outcomes. Epidural anesthesia/analgesia is one of these advances that is gaining rapid acceptance due to a perceived reduction in morbidity and overall patient satisfaction. Methods: A MEDLINE search was conducted for all pertinent articles on epidural anesthesia/analgesia. Results: Retrospective, prospective, and meta-analysis studies have demonstrated an improvement in surgical outcome through beneficial effects on perioperative pulmonary function, blunting the surgical stress response and improved analgesia. In particular, significant reduction in perioperative cardiac morbidity (similar to30%), pulmonary infections (similar to40%), pulmonary embolism (similar to50%), ileus (similar to2 days), acute renal failure (similar to30%), and blood loss (similar to30%) were noted in our review of the literature. Potential complications related to epidural anesthesia/analgesia range from transient paresthesias (< 10%) to potentially devastating epidural hematomas (0.0006%). Conclusions: Epidural anesthesia/analgesia has been demonstrated to improve postoperative outcome and attenuate the physiologic response to surgery.