Epidural anaesthesia and analgesia: better outcome after major surgery?BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7209.530 (Published 28 August 1999) Cite this as: BMJ 1999;319:530
Growing evidence suggests so
- Donal J Buggy, senior lecturer,
- Graham Smith, professor
- University Department of Anaesthesia and Pain Management, Leicester General Hospital, Leicester LE5 4PW
Major surgery induces profound physiological changes in the perioperative period, characterised by increases in sympathoadrenal and other neuroendocrine activity and also increased cytokine production Because epidural anaesthesia can attenuate this “stress response” to surgery, improve the quality of postoperative analgesia in comparison with systemic opioids, and hasten recovery of gut function, it has been suggested that conducting surgery under epidural anaesthesia (either as the sole anaesthetic or in combination with general anaesthesia) may reduce perioperative morbidity and mortality compared with general anaesthesia alone.1
Indeed, in a study of high risk patients undergoing major vascular surgery those who received combined general and epidural anaesthesia with postoperative epidural analgesia had significantly lower cardiac morbidity than those receiving general anaesthesia alone with postoperative systemic opioid analgesia.2 Unfortunately, subsequent studies have failed to confirm this finding. This uncertainty probably relates to the design, small size, and inadequate number of relevant studies for a meta-analysis of outcome; hence investigators in Australia are currently undertaking a large, multicentre study to address this question.
Though the effects of epidural anaesthesia on mortality and cardiac morbidity have been disappointing so far, the evidence that epidural anaesthesia decreases thromboembolic, pulmonary, …