EPIDURAL ANALGESICS - HOW CAN SAFETY AND EFFICACY BE IMPROVED

Numerous studies have shown that epidural anaesthesia/analgesia is a p owerful analgesic technique, but one which has a low therapeutic index . Although traditionally based on the use of local anaesthetics, epidu ral analgesia is now being performed using combinations of local anaes thetics and opioids with the aim of improving the quality of analgesia and reducing adverse effects. In recent years, there have been major advances in the evaluation of minimum effective doses and concentratio ns for local anaesthetics and opioids; this has obvious implications w hen considering safety in anaesthetic techniques, especially in the re lief of labour pain or postoperative incisional pain. Moreover, by imp lementing monitoring rules and analgesic protocols, the development of acute pain services has facilitated the use of epidural anaesthesia/a nalgesia and improved the therapeutic index of this technique.