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Epidural analgesia and outcome

Authors: Holte K, Kehlet H

Title: " Effect of postoperative epidural analgesia on surgical outcome"

Journal: Minerva Anestesiol 2002; 68:157-161

Type: scientific paper published in an international human anaesthesia journal

Language: English and Italian (Abstract only)

Background and M&M

Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controversial. We therefore update the effects of postoperative analgesia on surgical outcome.

Results and Conclusions

After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme.

The above is the abstract of a paper of written by H. Kehlet, a surgeon and a father of regional anaesthesia. Kehlet is also a contributor in the regional anaesthesia bible Neural blockade in clinical anaesthesia and management of pain. 3rd Ed. Philadelphia: Lippincott-Raven, 1998 (Eds: Cousins MJ, Bridenbaugh PS). The paper represents the summary of a lecture given by authors to the SMART Congress held in Milan in May 2002, and it is an astonishing source of information for veterinary surgeons interested in epidural anaesthesia and analgesia. The paper quotes 18 references.



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