Cardiovascular and Pulmonary Effects of Epidural Anaesthesia

Abstract

Epidural anaesthesia has been used since the early 1900s. Consequently the general characteristics of these procedures have been well defined. More studies have provided a better understanding of the cardiopulmonary changes produced by epidural anaesthesia. The cardiovascular effects observed with epidural anaesthesia are complex and variable, depending on a multitude of factors. The extent of sympathetic denervation, balance of sympathetic and parasympathetic activity, the pharmacological effect of systemically absorbed local anaesthetic agents, inclusion of adrenaline in the anaesthetic solution, the distribution of blood in relation to cardiac filling and cardiovascular function of the patient must be taken into account when considering the circulatory effects of epidural anaesthesia. Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block. Epidural anaesthesia that is restricted to the level of the low thoracic and lumbar region (T5-L4) results in a "peripheral" sympathetic blockade with vascular dilatation in the pelvis and lower limbs. High thoracic epidural anaesthesia, from the first to fifth thoracic, blocks the cardiac afferent and efferent sympathetic fibres with loss of chronotropic and inotropic drive to the myocardium. Thoracic epidural anaesthesia appears to at least partly reverse the diaphragmatic dysfunction that is a major determinant of the decrease in lung volumes observed after upper abdominal surgery. This article summarizes cardiovascular and pulmonary responses to epidural anaesthesia. Details of clinical management are not included in the review.

A survey of postoperative epidural and intravenous analgesia in Greece

“…In addition, in all these 10 departments, a sympathetic blockade of the lower extremities was induced, which may contribute to adverse effects, but not to an improvement of the upper abdominal or thoracic analgesia. For thoracic or upper abdominal surgery, thoracic epidural analgesia provides better dynamic analgesia compared to lumbar [18], and also improves gastrointestinal, respiratory and cardiac function [19,20], and decreases the risk of hypotension, urinary retention and limb weakness [21][22][23].…”

For Patients Undergoing Pancreatoduodenectomy, Epidural Anesthesia and Analgesia Improves Pain But Increases Rates of Intensive Care Unit Admissions and Alterations in Analgesics

“…8,9 Although the benefits of EAA are well established in patients undergoing cardiac or thoracic surgeries, its effects in patients undergoing abdominal surgeries are not completely determined. 10,11 A large, prospective, randomized, controlled study concluded that EAA provided improved postoperative analgesia for patients undergoing most abdominal surgeries. 12 However, other benefits, including shortened lengths of endotracheal intubation and intensive care unit (ICU) admission, were only demonstrated in patients undergoing abdominal aortic procedures.…”

Epidural ropivacaine infusion for the treatment of pain following axillary muscle-sparing thoracotomy: a dose-evaluation study

“…An extensive thoracic epidural block interferes with the sympathetic nerves (T1-4) and the splanchnic nerve (T6-L1), which can then produce substantial hypotension [17]. Indeed, Liu et al [18] have demonstrated that the postoperative thoracic epidural infusion of high-dose bupivacaine was associated with a trend for a higher incidence of orthostatic hypotension following thoracic surgery.…”