The role of epidural anesthesia and analgesia in surgical practice.

Advances in perioperative anesthesia and analgesia have improved pain relief and satisfaction in surgical patients. Opioid administered via patient-controlled analgesia (IV-PCA) provides better analgesia and patient satisfaction than conventional delivery. However, IV-PCA has not been demonstrated to affect postoperative outcome significantly. Recent studies suggest that advances in anesthesia and postoperative analgesia can affect postoperative outcome.1–3 Epidural anesthesia and analgesia have the potential to reduce or eliminate the perioperative physiologic stress responses to surgery and thereby decrease surgical complications and improve outcomes.1–3 The purposes of this review are to integrate experimental and clinical data addressing the physiologic effects of epidural anesthesia and postoperative epidural analgesia on surgical patients and to review the real and potential benefits of this technology with respect to patient outcomes. The effects of epidural anesthesia and analgesia on cardiovascular, coagulation, pulmonary, and gastrointestinal physiology; the surgical stress response; immune function; cognition; complications; and surgical outcomes will be reviewed separately.