Changing from Epidural to Multimodal Analgesia for Colorectal Laparotomy: An Audit

Cr, Chilvers; Nguyen, M. Hung; Robertson, IK

doi:10.1177/0310057x0703500213

Cited by 20 publications

(9 citation statements)

References 18 publications

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“…The 2 most common reasons were fear of litigation and a lack of evidence for beneficial effects. 49 Although serious complications are uncommon, patients should be informed about common adverse effects such as urinary retention and pruritus and should be counseled about the risks of major neurologic complications such as paralysis. The risks and benefits should be assessed on an individual patient basis.…”

Section: Risks Of Epidural Techniquesmentioning

confidence: 99%

Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

223

136

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Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.

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Section: Risks Of Epidural Techniquesmentioning

confidence: 99%

Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

223

136

View full text Add to dashboard Cite

show abstract

“…The efficacy of this practice has been corroborated in a retrospective case control audit of 113 patients having lower abdominal incisions (for colorectal surgery) 12 . Two and a half years of data from both before and after our conversion in 2002 from epidural analgesia to MM was collected and analysed.…”

mentioning

confidence: 87%

Future of Analgesia for Abdominal Laparotomy

Blackford

Hewitt

Pande

et al. 2008

ANZ Journal of Surgery

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“…In addition, with the increased use of low-molecular-weight heparin for deep venous thrombosis prophylaxis, there has been an increase in the incidence of epidural hematoma, primarily in elderly patients (7). A survey of Australian anesthesiologists showed that 82% of them had inserted fewer epidural catheters due to the fear of litigation and a lack of evidence for benefi cial eff ects (8). A good alternative to thoracic epidural analgesia for thoracotomies is paravertebral blocks due to a lower incidence of complications (9).…”

Section: Invited Commentarymentioning

confidence: 99%