Effect of epidural analgesia on postoperative outcomes

Epidural analgesia is a widely accepted analgesic technique for the treatment of postoperative pain. Compared to parenteral opioids, epidural analgesia in general will provide superior analgesia and may confer certain physiologic benefits, including attenuation of perioperative pathophysiologies, which may ultimately contribute to a decrease in perioperative morbidity or even mortality. High-risk surgical patients, such as those who are elderly, have decreased physiologic reserve or, undergoing certain procedures, may especially benefit from postoperative epidural analgesia. However, postoperative epidural management must be optimized to achieve any improvement in postoperative outcomes. Despite the potential benefits of postoperative epidural analgesia, the superiority of epidural analgesia compared to parenteral opioids is somewhat uncertain, which may be related to conflicting results of relatively small randomized controlled trials (RCTs) and other methodological issues. However, we limit our focus to larger RCTs, meta-analyses of RCTs, and large databases in an attempt to elucidate the benefits of postoperative epidural analgesia on conventional outcomes (eg, mortality, major morbidity) and patient-reported outcomes (eg, satisfaction, quality of recovery, and analgesia). Mortality: The overall advances in anesthesia care have significantly decreased the incidence of mortality since the late 1960s, as reflected in the Institute of Medicine report on medical errors (ie, “anesthesiology has successfully reduced anesthesia mortality rates from two deaths per 10,000 anesthetics administered, to one death per 200,000–300,000 anesthetics administered”).