title: Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer.
abstract: OBJECTIVE
  Analgesia and early quality of recovery may be improved by epidural analgesia. We aimed to assess the effect of receiving epidural analgesia on surgical adverse events and quality of life after laparotomy for endometrial cancer.
  
  
  METHODS
  Patients were enrolled in an international, multicentre, prospective randomised trial of outcomes for laparoscopic versus open surgical treatment for the management of apparent stage I endometrial cancer (LACE trial). The current analysis focussed on patients who received an open abdominal hysterectomy via vertical midline incision only (n=257), examining outcomes in patients who did (n=108) and did not (n=149) receive epidural analgesia.
  
  
  RESULTS
  Baseline characteristics were comparable between patients with or without epidural analgesia. More patients without epidural (34%) ceased opioid analgesia 3-5 days after surgery compared to patients who had an epidural (7%; p<0.01). Postoperative complications (any grade) occurred in 86% of patients with and in 66% of patients without an epidural (p<0.01) but there was no difference in serious adverse events (p=0.19). Epidural analgesia was associated with increased length of stay (up to 48 days compared to up to 34 days in the non-epidural group). There was no difference in postoperative quality of life up to six months after surgery.
  
  
  CONCLUSIONS
  Epidural analgesia was associated with an increase in any, but not serious, postoperative complications and length of stay after abdominal hysterectomy. Randomised controlled trials are needed to examine the effect of epidural analgesia on surgical adverse events, especially as the present data do not support a quality of life benefit with epidural analgesia.
authors.affiliation: The University of Queensland, Burns, Trauma and Critical Care Research Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia. Electronic address: david@belavy.com.
authors.forename: David
authors.initials: D
authors.lastname: Belavy
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Jannah
authors.initials: J
authors.lastname: Baker
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Adverse events; Endometrial cancer; Epidural; Hysterectomy