The role of epidural anesthesia and analgesia in surgical practice.
OBJECTIVE
To review the potential and proven benefits and complications of epidural anesthesia/analgesia.


BACKGROUND
Advances in analgesia/anesthesia have improved patient satisfaction and perioperative outcomes. Epidural anesthesia/analgesia is one of these advances that is gaining rapid acceptance due to a perceived reduction in morbidity and overall patient satisfaction.


METHODS
A MEDLINE search was conducted for all pertinent articles on epidural anesthesia/analgesia.


RESULTS
Retrospective, prospective, and meta-analysis studies have demonstrated an improvement in surgical outcome through beneficial effects on perioperative pulmonary function, blunting the surgical stress response and improved analgesia. In particular, significant reduction in perioperative cardiac morbidity ( approximately 30%), pulmonary infections ( approximately 40%), pulmonary embolism ( approximately 50%), ileus ( approximately 2 days), acute renal failure ( approximately 30%), and blood loss ( approximately 30%) were noted in our review of the literature. Potential complications related to epidural anesthesia/analgesia range from transient paresthesias (<10%) to potentially devastating epidural hematomas (0.0006%).


CONCLUSIONS
Epidural anesthesia/analgesia has been demonstrated to improve postoperative outcome and attenuate the physiologic response to surgery.
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
Robert J
RJ
Moraca
David G
DG
Sheldon
Richard C
RC
Thirlby
D015360:Analgesia, Epidural; D000767:Anesthesia, Epidural; D013505:Digestive System Surgical Procedures; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D013312:Stress, Physiological / Q000503:physiopathology; D013514:Surgical Procedures, Operative; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures