Epidural analgesia in gastrointestinal surgery.
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.


METHODS
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.


CONCLUSIONS
Epidural analgesia enhances recovery after gastrointestinal surgery. The results support the development of structured regimens of early postoperative feeding and mobilization to exploit the potential for thoracic epidural analgesia to reduce hospital stay after gastrointestinal surgery.
Fotiadis
R J
RJ
Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Imperial College London, London, UK.
Badvie
S
S
Weston
M D
MD
Allen-Mersh
T G
TG
D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000714:Anastomosis, Surgical; D000779:Anesthetics, Local / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000209:etiology; D016063:Blood Loss, Surgical; D005767:Gastrointestinal Diseases / Q000503:physiopathology / Q000601:surgery*; D006331:Heart Diseases / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D045823:Ileus / Q000209:etiology; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D013529:Surgical Wound Dehiscence / Q000209:etiology
D000779:Anesthetics, Local; D009294:Narcotics