This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Epidural analgesia in gastrointestinal surgery. BJS 2004; 91: 828-841.
Published: 21st May 2004
Authors: R. J. Fotiadis, S. Badvie, M. D. Weston, T. G. Allen‐Mersh
Background
The ideal perioperative analgesia should provide effective pain relief, avoid the detrimental effects of the stress response, be simple to administer without the need for intensive monitoring, and have a low risk of complications.
Method
This review defines the physiological effects of epidural analgesia and assesses whether the available evidence supports its preferential use in gastrointestinal surgery. All papers studied were identified from a Medline search or selected by cross‐referencing.
Results
Epidural analgesia is associated with a shorter duration of postoperative ileus, attenuation of the stress response, fewer pulmonary complications, and improved postoperative pain control and recovery. It does not reduce anastomotic leakage, intraoperative blood loss, transfusion requirement, risk of thromboembolism or cardiac morbidity, or hospital stay compared with that after conventional analgesia in unselected patients undergoing gastrointestinal surgery. Thoracic epidural analgesia reduces hospital costs and stay in patients at high risk of cardiac or pulmonary complications.