Prolonged epidural analgesia after major urologic surgery

The benefits of epidural analgesia are well known, but it is not well under stood which types of urologic surgery benefit most from epidural analgesia. In this study, the effects and side effects of prolonged epidural analgesi a are prospectively examined and analysed on 172 adult patients in three di fferent operation groups. An epidural infusion of local anaesthetic combine d with an opioid and adrenaline was given for a period of 5-7 days. There w as no difference between the groups with respect to the effectiveness of th e analgesia and patients' perception of the treatment. Mobilization differe d, as expected, between the groups, however even after the most major surge ry (e.g. cystectomy with bladder substitution), mobilization was impressive ly unproblematic. Retarded return of regular intestinal function after the transperitoneal operation and partly after lumbotomy compared with the extr aperitoneal operation depended on which operation was performed and the amo unt of analgesia given. The side effects such as sedation, nausea and pruri tis were conditional partly on the opiate and partly on the intervention. U p to 11 % showed slight muscular weakness of the lower limbs as a specific side effect of the local anaesthetic. Complications: One patient died of ce rebral hypoxy due to an initially undetected subdural catheter placement co mplicated by severe pre-existent carotid stenosis. In four patients, the ep idural analgesia had to be stopped because of catheter migration. There was no clinical evidence of hematoma, abscess or permanent neurological damage . Epidural analgesia works well in terms of analgesia, mobilization and pat ient satisfaction, bearing in mind the potential side effects and complicat ions. It can be recommended for lumbotomy and long transperitoneal operatio ns however not for extraperitoneal interventions in the lower abdomen such as radical prostatectomy.