Benefits, Risks and Complications of Perioperative Use of Epidural Anesthesia
Dragana Unic-Stojanovic, Srdjan Babic, Miomir Jovic
Med Arh. 2012; 66(5): 340-343

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Use of thoracic epidurals is widespread for intraoperative and postoperative analgesia. Thoracic epidural anaesthesia (TEA) reduces sympathetic activity and thereby influences perioperative function of vital organ systems. A results of recent studies suggest that TEA decreases postoperative morbidity and mortality. There is better pain control with TEA in a wide range of surgical procedures. Use of TEA is associated with the risk of harm, but also the other methods used to control perioperative pain and stress response carry specific risks. Timely diagnosis and treatment of spinal compression or infection are crucial to ensure patient safety with TEA. The benefits of TEA outweigh the risks with respect to the perioperative outcome and organ protection, if basic guidelines are followed.


1. Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH. Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lancet. 2008; 372: 1962-1976.

2. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Anesthesiology. 1995; 82: 1474-1506.

3. Moraca RJ, Sheldon DG, Thirlby RC. The Role of Epidural Anesthesia and Analgesia in Surgical Practice. Ann Surg. 2003; 238(5): 663-673.

4. Blomberg S, Emanuelsson H, Kvist H, et al. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology. 1990; 73: 840-847.

5. Nygard E, Kofoed KF, Freiberg J, et al. Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease. Circulation.2005; 111: 2165-2170.

6. Schmidt C, Hinder F, Van Aken H, et al. The effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease. Anesth Analg. 2005; 100: 1561-1569.

7. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S: Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000; 321: 1493.

8. Taniguchi M, Kasaba T, Takasaki M: Epidural anesthesia enhances sympathetic nerve activity in the unanesthetized segments in cats. Anesth Analg. 1997; 84: 391-397.

9. Meissner A, Rolf N, Van Aken H: Thoracic epidural anesthesia and the patient with heart disease: benefits, risks, and controversies. Anesth Analg. 1997; 85: 517-528.

10. Popping DM, Elia N, Marret E, Remy C, Tramer MR: Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008; 143: 990-999.

11. Park WY, Thompson JS, Lee KK: Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. AnnSurg. 2001; 234: 560-569.

12. Baron JF, Bertrand M, Barre E, et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology. 1991; 75: 611-618.

13. Beattie WS, Badner NH, Choi P: Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001; 93:853-858.

14. Warner DO: Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology 2000; 92:1467-1472.

15. Wu CL, Hurley RW, Anderson GF, Herbert R, Rowlingson AJ, Fleisher LA: Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients. Reg Anesth Pain Med 2004; 29:525-533.

16. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS: Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359:1276-1282.

17. Smetana GW: A 68-year-old man with COPD contemplating colon cancer surgery. JAMA. 2007; 297: 2121-2123.

18. Lawrence VA, Cornell JE, Smetana GW, American College of Physicians: Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: Systematic review for the American College of Physicians. Ann Intern Med. 2006; 144: 596-608.

19. Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998; 86: 598-612.

20. Panaretou V, Toufektzian L, Siafaka I, Kouroukli I, Sigala F, Vlachopoulos C, Katsaragakis S, Zografos G, Filis K. Postoperative pulmonary function after open abdominal aortic aneurysm repair in patients with chronic obstructive pulmonary disease: epidural versus intravenous analgesia. Annals of Vascular Surgery. 2012; 26(2): 149-155.

21. Borghi B, Casati A, Iuorio S, et al. Frequency of hypotension and bradycardia during general anesthesia, epidural anesthesia, or integrated epidural-general anesthesia for total hip replacement. J Clin Anesth. 2002; 14: 102-106.

22. Lier F. Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease. Anesthesiology. 2011; 115: 315-321.

23. Nishimori M, Ballantyne JC, Low JH. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2006;3: CD005059.

24. Peyton PJ, Myles PS, Silbert BS, Rigg JA, Jamrozik K, Parsons R: Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients. Anesth Analg. 2003; 96: 548-554.

25. Takasaki M, Takahashi T. Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br J Anaesth. 1980; 52: 1271-1276.

26. Sundberg A, Wattwil M, Arvill A. Respiratory effects of high thoracic epidural anaesthesia. Acta Anaesthesiol Scand. 1986; 30: 215-217.

27. Tuman KJ, McCarthy RJ, March RJ, et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg. 1991; 73: 696-704.

28. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001; 87: 62-72.

29. Delis KT, Knaggs AL, Mason P, Macleod KG. Effects of epidural-and-general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb. A randomized study. Thromb Haemost. 2004; 92: 1003-1011.

30. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004: CD000521.

31. Freise H, Daudel F, Grosserichter C, et al. Thoracic epidural anesthesia reverses sepsis-induced hepatic hyperperfusion and reduces leukocyte adhesion in septic rats. Crit Care. 2009; 13: R116.

32. Freise H, Lauer S, Konietzny E, et al. Hepatic effects of thoracic epidural analgesia in experimental severe acute pancreatitis. Anesthesiology. 2009; 111: 1249-1256.

33. Mythen MG: Postoperative gastrointestinal tract dysfunction. Anesth Analg. 2005; 100: 196-204.

34. Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc. 2007; 21: 247-252.

35. Freise H, Fischer LG. Intestinal effects of thoracic epidural anesthesia. Curr Opin Anaesthesiol. 2009; 22: 644-648.

36. Baig MK, Wexner SD. Postoperative ileus: a review. Dis Colon Rectum. 2004; 47: 516-526.

37. Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br. J. Anaesth. 2011; 107(6): 859-868.

38. Schwarte LA, Picker O, Hohne C, Fournell A, Scheeren TW. Effects of thoracic epidural anaesthesia on microvascular gastric mucosal oxygenation in physiological and compromised circulatory conditions in dogs. Br J Anaesth. 2004; 93: 552-559.

39. Adolphs J, Schmidt DK, Korsukewitz I, et al. Effects of thoracic epidural anaesthesia on intestinal microvascular perfusion in a rodent model of normotensive endotoxaemia. Intensive Care Med. 2004; 30: 2094-2101.

40. Fotiadis RJ, Badvie S, Weston MD, Allen-Mersh TG: Epidural analgesia in gastrointestinal surgery. Br J Surg. 2004; 91: 828-841.

41. Lattermann R, Wykes L, Eberhart L, Carli F, Meterissian S, Schricker T: A randomized controlled trial of the anticatabolic effect of epidural analgesia and hypocaloric glucose. Reg Anesth Pain Med. 2007; 32: 227-232.

42. Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, Lin EE, Liu SS: Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology. 2005; 103: 1079-1088.

43. Carli F, Trudel JL, Belliveau P: The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective, randomized trial. Dis Colon Rectum 2001; 44:1083-1089.

44. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 2005; CD004088

45. Wijeysundera DN, Beattie WS, Austin PC, Hux JE, Laupacis A: Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study. Lancet 2008; 372:562-569.

46. McGregor WE, Koler AJ, Labat GC, et al. Awake aortic aneurysm repair in patients with severe pulmonary disease. Am J Surg. 1999; 178:121-124.

47. Grewal S, Hocking G, Wildsmith JA: Epidural abscesses. Br J Anaesth 2006; 96:292–302

48. Auroy Y, Narchi P, Messiah A, et al. Serious complications related to regional anesthesia. Anesthesiology. 1997; 87:479-486.

49. Horlocker TT. Regional anesthesia: complications of spinal and epidural anesthesia. Anesthesiol Clin North America. 2000; 18:461-485.

50. Tanaka K, Watanabe R, Harada T, et al. Extenzive applications of epidural anesthesia and analgesia in a university hospital; incidence of complications related to tehnique: Reg Anesth. 1993; 1048-1056.

51. Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981; 60: 150-161.

52. Schmidt A, Nolte H. Subdural and epidural hematoma following epidural anesthesia: a literature review. Anaesthesist. 1992; 41: 276-284.

53. Tyrba M. Epidural regional anesthesia and low molecular heparin: Pro (German). Anasth Intensivmed Notfallmed Schmerzther. 1993; 28: 179-181

54. Lim SH, Hong BY, Cho YR, et al. Relapsed spontaneous spinal epidural hematoma associated with aspirin and clopidogrel. Neurol Sci 2011; 32: 687-689.

55. Moon HJ, Kim JH, Kwon TH, Chung HS, Park YK. Spontaneous spinal epidural hematoma: an urgent complication of adding clopidogrel to aspirin therapy. J Neurol Sci. 2009; 285: 254-256.

56. Omori N, Takada E, Narai H, Tanaka T, Abe K, Manabe Y. Spontaneous cervical epidural hematoma treated by the combination of surgical evacuation and steroid pulse therapy. Intern Med. 2008; 47: 437-440.

57. Breivik H, Bang U, Jalonen J, Vigfusson G, Alahuhta S, Lagerkranser M. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand. 2010; 54: 16-41

58. Vandermeulen Ep, Van aken H. Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994; 79: 1165-1177.

59. Gogarten W, Vandermeulen E, Van Aken H, Kozek S, Llau JV, Samama CM. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol. 2010; 27: 999-1015.

60. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133: 381S-453S.

61. Oscarsson A, Gupta A, Fredrikson M, et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth. 2010; 104: 305-312.

62. Grines CL, Boniw RO, Casez DE, et al, Prevention of premature discontiunation of dual antiplatelet therapz in patients with coronarz arterz stents. Circulation. 2007; 115: 813-818.

63. Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007; 99: 316-328.

64. Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br. J. Anaesth. 2011; 107(1): i90-i95.

65. Bode RH Jr, Lewis KP, Zarich SW, et al. Cardiac outcome after peripheral vascular surgery: comparison of general and regional anesthesia. Anesthesiology. 1996; 84: 3-13.

66. McLeod GA at al. Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia. 2001; 56: 75-81.

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