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Epidural technique for postoperative pain: gold standard no more?
MedLine Citation:
PMID:  22531384     Owner:  NLM     Status:  In-Data-Review    
ABSTRACT: Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.
Narinder Rawal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  37     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  310-7     Citation Subset:  IM    
From the Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
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