Epidural analgesia in gastrointestinal surgery

被引:70
作者
Fotiadis, RJ
Badvie, S
Weston, MD
Allen-Mersh, TG
机构
[1] Univ London Imperial Coll Sci & Technol, Div Surg Anaesthet & Intens Care, Fac Med, London, England
[2] Chelsea & Westminster Healthcare Trust, Dept Anaesthet Intens Care & Pain Management, London, England
关键词
D O I
10.1002/bjs.4607
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. The ideal perioperative analgesia should provide effective pain relief, avoid the detrimental effects of the stress response, be simple to administer without the need for intensive monitoring, and have a low risk of complications. Methods: This review defines the physiological effects of epidural analgesia and assesses whether the available evidence supports its preferential use in gastrointestinal surgery. All papers studied were identified from a Medline search or selected by cross-referencing. Results: Epidural analgesia is associated with a shorter duration of postoperative ileus, attenuation of the stress response, fewer pulmonary complications, and improved postoperative pain control and recovery. It does not reduce anastomotic leakage, intraoperative blood loss, transfusion requirement, risk of thromboembolism or cardiac morbidity, or hospital stay compared with that after conventional analgesia in unselected patients undergoing gastrointestinal surgery. Thoracic epidural analgesia reduces hospital costs and stay in patients at high risk of cardiac or pulmonary complications. Conclusions: Epidural analgesia enhances recovery after gastrointestinal surgery. The results support the development of structured regimens of early postoperative feeding and mobilization to exploit the potential for thoracic epidural analgesia to reduce hospital stay after gastrointestinal surgery.
引用
收藏
页码:828 / 841
页数:14
相关论文
共 158 条
[1]   EFFECT OF CONTINUOUS POSTOPERATIVE EPIDURAL ANALGESIA ON INTESTINAL MOTILITY [J].
AHN, H ;
BRONGE, A ;
JOHANSSON, K ;
YGGE, H ;
LINDHAGEN, J .
BRITISH JOURNAL OF SURGERY, 1988, 75 (12) :1176-1178
[2]   HIGH SPINAL NERVE BLOCK FOR LARGE BOWEL ANASTOMOSIS - RETROSPECTIVE STUDY [J].
AITKENHEAD, AR ;
WISHART, HY ;
PEEBLESBROWN, DA .
BRITISH JOURNAL OF ANAESTHESIA, 1978, 50 (02) :177-183
[3]   VISCERAL PAIN DURING CESAREAN-SECTION UNDER SPINAL AND EPIDURAL-ANESTHESIA WITH BUPIVACAINE [J].
ALAHUHTA, S ;
KANGASSAARELA, T ;
HOLLMEN, AI ;
EDSTROM, HH .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1990, 34 (02) :95-98
[4]   CONSEQUENCES OF POSTOPERATIVE ALTERATIONS IN RESPIRATORY MECHANICS [J].
ALI, J ;
WEISEL, RD ;
LAYUG, AB ;
KRIPKE, BJ ;
HECHTMAN, HB .
AMERICAN JOURNAL OF SURGERY, 1974, 128 (03) :376-382
[5]  
[Anonymous], 1900, SEMAINE MEDICALE
[6]   Severe complications associated with epidural and spinal anaesthesias in Finland 1987-1993. A study based on patient insurance claims [J].
Aromaa, U ;
Lahdensuu, M ;
Cozanitis, DA .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1997, 41 (04) :445-452
[7]   The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials [J].
Ballantyne, JC ;
Carr, DB ;
deFerranti, S ;
Suarez, T ;
Lau, J ;
Chalmers, TC ;
Angelillo, IF ;
Mosteller, F .
ANESTHESIA AND ANALGESIA, 1998, 86 (03) :598-612
[8]   EPIDURAL MORPHINE REDUCES THE RISK OF POSTOPERATIVE MYOCARDIAL-ISCHEMIA IN PATIENTS WITH CARDIAC RISK-FACTORS [J].
BEATTIE, WS ;
BUCKLEY, DN ;
FORREST, JB .
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 1993, 40 (06) :532-541
[9]   Epidural analgesia reduces postoperative myocardial infarction: A meta-analysis [J].
Beattie, WS ;
Badner, NH ;
Choi, P .
ANESTHESIA AND ANALGESIA, 2001, 93 (04) :853-858
[10]   Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia [J].
Beattie, WS ;
Badner, NH ;
Choi, PTL .
ANESTHESIA AND ANALGESIA, 2003, 97 (03) :919-920