title: Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients.
abstract: In a primary analysis of a large recently completed randomized trial in 915 high-risk patients undergoing major abdominal surgery, we found no difference in outcome between patients receiving perioperative epidural analgesia and those receiving IV opioids, apart from the incidence of respiratory failure. Therefore, we performed a selected number of predetermined subgroup analyses to identify specific types of patients who may have derived benefit from epidural analgesia. We found no difference in outcome between epidural and control groups in subgroups at increased risk of respiratory or cardiac complications or undergoing aortic surgery, nor in a subgroup with failed epidural block (all P > 0.05). There was a small reduction in the duration of postoperative ventilation (geometric mean [SD]: control group, 0.3 [6.5] h, versus epidural group, 0.2 [4.8] h; P = 0.048). No differences were found in length of stay in intensive care or in the hospital. There was no relationship between frequency of use of epidural analgesia in routine practice outside the trial and benefit from epidural analgesia in the trial. We found no evidence that perioperative epidural analgesia significantly influences major morbidity or mortality after major abdominal surgery.
authors.affiliation: Department of Anesthesia, Austin and Repatriation Medical Centre, Melbourne, Australia. phil@austin.unimelb.edua.u
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Peyton
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
authors.forename: Brendan S
authors.initials: BS
authors.lastname: Silbert
authors.forename: John A
authors.initials: JA
authors.lastname: Rigg
authors.forename: Konrad
authors.initials: K
authors.lastname: Jamrozik
authors.forename: Richard
authors.initials: R
authors.lastname: Parsons
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000601:surgery; D003422:Critical Care; D023381:Endpoint Determination; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid