Effect of Postoperative Epidural Analgesia on Patient Outcomes

The overall benefits of perioperative epidural anesthesia and analgesia for decreasing morbidity and mortality is controversial. However, perioperative epidural anesthesia and analgesia will attenuate detrimental perioperative pathophysiology, which, in turn, may diminish the incidence of adverse patient outcomes. There are increasing experimental and clinical data to support the use of perioperative epidural anesthesia and analgesia for decreasing postoperative pulmonary, gastrointestinal, and cardiovascular complications. One of the primary reasons that the "regional versus general anesthesia" question has not been answered is due to the significant methodological issues present in every available trial, which affect the interpretation and limit the applicability of the trial results. A major issue in the overall interpretation of results from trials examining the effect of postoperative epidural analgesia on patient outcomes is that "epidural analgesia" is commonly viewed as a generic term. There are clinical and outcome implications for various inputs into what constitutes "epidural analgesia," including the duration of epidural analgesia, analgesic contents (eg, local anesthetics versus opioids), and location of catheter placement. We will examine these issues along with the role of epidural analgesia in the multimodal approach for patient recovery.