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October 1, 2020Minerva Anestesiologica

Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives?

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Why the study?

Implementation of enhanced recovery after surgery protocols and shifts from open to laparoscopic surgery have diminished the advantages of epidural anesthesia, prompting a re-evaluation of its perioperative role.

Does epidural anesthesia improve perioperative analgesia compared to alternative methods in patients undergoing abdominal surgery with ERAS protocols?

Population

Patients undergoing open and laparoscopic abdominal surgery across two meta-analyses

Comparison

Epidural analgesia vs control or alternative analgesia methods

Design

Review summarizing two meta-analyses

Authors

MWM. F. M. WagemansWSWillem ScholtenMHMarkus W. Hollmann

Discussion

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Member takes

Overview

May warrant reduced EA reliance in laparoscopic ERAS cases; leaves open optimal analgesia strategies in contemporary protocols.

Structured PICO

Does epidural anesthesia improve perioperative analgesia compared to alternative methods in patients undergoing abdominal surgery with ERAS protocols?

P
Population
Patients undergoing open and laparoscopic abdominal surgery
I
Intervention
Epidural anesthesia
C
Comparator
Control or alternative analgesic methods (e.g., intravenous ketamine, peripheral nerve blocks, continuous wound infiltration, intrathecal morphine, intravenous and non-invasive PCA)
O
Outcome
Perioperative analgesia efficacy and complications

In the era of ERAS protocols, epidural anesthesia for abdominal surgery is no longer the preferred standard of care due to a lack of clinical superiority and a higher risk of serious neurological complications.

Cite This Study

Wagemans et al. (2020) studied this question.

synapsesocial.com/papers/6a761dedb52b7ee7dcfbdd32https://doi.org/10.23736/s0375-9393.20.14324-4
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies2016 · 76 citations
  2. 2Epidural Analgesia and Postoperative Outcome—Clinical Recommendations?2015 · 3 citations
  3. 3Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities2016 · 271 citations
  4. 4Epidural Analgesia Enhances Functional Exercise Capacity and Health-related Quality of Life after Colonic Surgery2002 · 380 citations
  5. 5Epidural Technique for Postoperative Pain2012 · 248 citations