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Analgesia in Major Abdominal Surgery pp 115–147Cite as

Thoracic Epidural Analgesia

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Abstract

For decades, epidural infusions of local anaesthetic have been a mainstay of providing analgesia following abdominal surgery. Early studies suggested that epidural analgesia was associated with better post-operative outcomes: lower rates of respiratory failure, ileus, intraoperative bleeding and thrombosis which appeared to translate to a reduction in peri-operative mortality. However, following the advent of laparoscopic surgery and Enhanced Recovery techniques the peri-operative landscape has now changed. Epidural analgesia is associated with complications that can delay patient recovery, and clinicians are now finding multimodal analgesic techniques that are effective as epidurals at relieving post-operative pain. Because of advances in peri-operative care, much of the evidence that supports outcome benefits of epidural analgesia may no longer be valid. This chapter examines the current evidence for outcome benefits of thoracic epidural analgesia (TEA), and aims to identify the role that TEA may occupy in the future of ERAS for abdominal surgery.

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Authors and Affiliations

  1. Department of Anaesthesia, Borders General Hospital, Melrose, Roxburgshire, UK

    Jonathan Antrobus

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  1. Jonathan Antrobus
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  1. Department of Anaesthetics and Critical Care, Royal Blackburn Hospital, Blackburn, Lancashire, UK

    Anton Krige

  2. Department of Anesthesiology and Critical Care, Virginia Commonwealth University Hospital, Richmond, VA, USA

    Michael J. P. Scott

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Antrobus, J. (2018). Thoracic Epidural Analgesia. In: Krige, A., Scott, M. (eds) Analgesia in Major Abdominal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94482-1_8

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