Effect of epidural anesthesia and analgesia on perioperative outcome - A randomized, controlled Veterans Affairs Cooperative Study

Objective To test the hypothesis that epidural anesthesia and postoperative epidural analgesia decrease the incidence of death and major complications during an d after four types of intraabdominal surgical procedures. Summary Background Data Even though many beneficial aspects of epidural anesthesia have been report ed, clinical trials of epidural anesthesia for outcome of surgical patients have shown conflicting results. Methods The authors studied 1,021 patients who required anesthesia for one of the i ntraabdominal aortic, gastric, biliary, or colon operations. They were assi gned randomly to receive either general anesthesia and postoperative analge sia with parenteral opioids (group 1) or epidural plus light general anesth esia and postoperative epidural morphine (group 2). The patients were monit ored for death and major complications during and for 30 days after surgery , as well as for postoperative pain, time of ambulation, and length of hosp ital stay. Results Overall, there was no significant difference in the incidence of death and major complications between the two groups. For abdominal aortic surgical p atients, unlike the other three types of surgical patients, the overall inc idence of death and major complications was significantly lower in group 2 patients (22%) than in group 1 patients (37%), stemming from differences in the incidence of new myocardial infarction, stroke, and respiratory failur e between the two groups. Overall, group 2 patients received significantly less analgesic medication but had better pain relief than group 1 patients. In group 2 aortic patients, endotracheal intubation time was 13 hours shor ter and surgical intensive care stay was 3.5 hours shorter. Conclusions The effect of anesthetic and postoperative analgesic techniques on perioper ative outcome varies with the type of operation performed. Overall, epidura l analgesia provides better postoperative pain relief. Epidural anesthesia and epidural analgesia improve the overall outcome and shorten the intubati on time and intensive care stay in patients undergoing abdominal aortic ope rations.