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Safety and efficacy of epidural analgesia

Bos, Elke M.E.a; Hollmann, Markus W.a; Lirk, Philippb

Current Opinion in Anaesthesiology: December 2017 - Volume 30 - Issue 6 - p 736–742
doi: 10.1097/ACO.0000000000000516
TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles

Purpose of review Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain.

Recent findings Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia. The debate continues whether epidural analgesia leads to decreased complications and improved outcome. Noninferiority of alternative regional analgesic approaches, that is continuous-wound-infiltration, peripheral nerve blocks or surgical site infiltration, appears to be present and is promising for the future. Serious adverse events after epidural analgesia seem to occur more often than was previously thought and clinicians must realize that incidence rates differ in specific perioperative patient populations.

Summary Epidural analgesia for obstetric analgesic purposes is considered to be well tolerated in young, healthy women, since efficacy has been proven and complications leading to permanent neurological damage seldomly occur. Safety of epidural analgesia for perioperative and chronic pain treatment is more difficult to balance; careful selection of appropriate patients cannot be over-emphasized.

aDepartment of Anesthesiology, Academisch Medisch Centrum, Amsterdam, The Netherlands

bDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Philipp Lirk, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Tel: +1 617 732 8210; e-mail:

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