Safety and efficacy of postoperative epidural analgesia.

Effective analgesia for postoperative pain relief after major surgery has been a practical proposition with epidural administration of local anaesthetic (LA) and opioid drugs since the early 1980s. Although epidural administration is perceived by 80% of UK anaesthetists as the ideal analgesic technique for upper abdominal surgery, there are many patients undergoing major surgery who do not receive this form of analgesia. In a recent survey of UK practice, only 15% of patients undergoing abdominal surgery had epidural analgesia in the 12 hospitals sampled. The main factor which has limited the use of epidural analgesia has been the dif®culty in making a reasonable risk/bene®t analysis about the technique, which has resulted in clinicians constantly asking whether epidurals are effective for postoperative pain relief and whether the technique is safe. This review considers the ef®cacy and safety of epidural analgesia in patients recovering from major surgery and is based on a computerized search of the literature from 1976 to 2000 (EMBASE/Medline). The ®nal section will deal with the organizational issues which need to be considered to maximize ef®cacy and safety and is based on the authors' joint experience of supervising acute pain services (APS) in New Zealand and the UK; these services have been responsible for pain relief in over 20 000 patients nursed on general postoperative wards.