The poor man's epidural: systemic local anesthetics for improving postoperative outcomes.
The inflammatory response is an important determinant of outcome after major surgery. Perioperative excessive stimulation of the inflammatory and hemostatic systems plays a role in the development of postoperative ileus, ischemia-reperfusion syndromes (e.g. myocardial infarction), hypercoagulation syndromes (e.g. deep venous thrombosis) and pain; together, these represent a significant fraction of major postoperative disorders. Epidurally administered local anesthetics prevent or modulate many of these processes. Since local anesthetics show inflammatory modulating properties in vitro and in vivo, they might also prevent these postoperative inflammatory processes when administered intravenously. Clinical studies have shown that perioperative local anesthetic administration significantly reduces the incidence of thrombosis and postoperative pain, shortens postoperative ileus and decreases hospital stay. On this basis we hypothesize that continuous intravenous administration of local anesthetic perioperatively might prevent or reduce several postoperative disorders resulting from excessive stimulation of inflammatory and hemostatic systems, and thereby improve surgical outcome.
Hollmann
Markus W
MW
Department of Anesthesiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany. markus_hollmann@med.uni-heidelberg.de
Strümper
Danja
D
Durieux
Marcel E
ME
D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D006801:Humans; D045823:Ileus / Q000517:prevention & control; D007262:Infusions, Intravenous / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome
D000779:Anesthetics, Local