Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery

Nishimori M, Ballantyne JC, Low JH.S.

Summary

Epidural analgesia provides greater pain relief and faster removal of a tracheal tube after open abdominal aortic surgery compared to systemic opioid-based pain relief

Surgery on the abdominal aorta (the main artery to the legs) requires aggressive postoperative pain management. Epidurals (pain medications injected into the spinal canal) or systemic opioids (morphine-like drugs injected systemically) are most commonly used. The effect of these two methods on postoperative complications and mortality after abdominal aortic surgery has not been previously clarified. This review found that epidural analgesia reduces the postoperative duration of tracheal intubation by approximately 20%, and provides better pain management for up to three postoperative days regardless of the site of epidural catheter placement and epidural medications used. Epidural analgesia, especially thoracic epidural, also provided reduced incidences of postoperative cardiac complications; prolonged mechanical ventilation, (use of a machine to improve the exchange of air between the lungs and the atmosphere); gastrointestinal complications; and renal insufficiency. However the mortality was unchanged. Most of the patients with epidural pain management also had epidural anaesthesia for the surgical procedure.