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Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery

Weiss, Raphael; Pöpping, Daniel M.

Current Opinion in Anesthesiology: October 2018 - Volume 31 - Issue 5 - p 622–629
doi: 10.1097/ACO.0000000000000640
REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany

Purpose of review Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications.

Recent findings In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmias and pneumonia. When it is embedded into a multimodal fast-track program, it also shortens intensive care and hospital stay.

Summary TEA provides superior pain control with a handful of important advantages if used sensibly and with caution. Because of associated risks for severe neurological complications, clear contraindications should be ruled out. Special attention needs be paid to potential hypotension in the setting of epidural analgesia. If these key points are considered, a TEA still represents a viable option for enhanced recovery after major abdominal surgery.

University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, Münster, NRW, Germany

Correspondence to Raphael Weiss, MD, University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, 48149 Münster, NRW, Germany. Tel: +49 251 83 47266; fax: +49 251 83 47257; e-mail: r_weiss@anit.uni-muenster.de

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