Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery

Guay, Joanne; Kopp, Sandra L.

doi:10.1002/14651858.cd005059.pub4

Cited by 85 publications

(47 citation statements)

References 83 publications

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“…Insbesondere Patienten mit kardiovaskulären Vorerkrankungen scheinen zu profitieren, wie eine große Metaanalyse von Guay Patienten mit abdominellen Aneurysmaoperationen, die unter TEA signifikant weniger Komplikationen (z. B. Myokardinfarkte) entwickelten [10].…”

Section: Einfluss Auf Organsystemeunclassified

PRO: Epiduralanalgesie – Goldstandard bei abdominalen und thorakalen Eingriffen

Listing¹,

Pöpping²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Pain relief with epidural analgesia is superior compared to systemic opioid analgesia after major abdominal and thoracic surgery. It remains a safe procedure, as long as it is embedded in a concept covering the whole perioperative period. This includes the knowledge of the anesthesiologist how to operate the process of catheter insertion as well as to treat complications like the hypotension, associated with the application of epidural local anesthetics. A close postoperative monitoring by an acute pain service team is a responsible task and should be available 24/7. Despite the low incidence of complications, their consequences could be disastrous for patients. To avoid persisting neurological damage, standardized diagnostic procedures must be established and surgical intervention should be available within six hours if necessary. Non-analgetic benefits of epidural analgesia include reduced pulmonary complications like pneumonia and lower incidences for cardiac arrhythmia. Furthermore, perioperative mortality could be decreased by epidural analgesia. These effects should be considered as "add-on". The excellent pain relief is more than enough to recommend this method.

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Section: Einfluss Auf Organsystemeunclassified

PRO: Epiduralanalgesie – Goldstandard bei abdominalen und thorakalen Eingriffen

Listing¹,

Pöpping²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…A meta-analysis [22] suggested slightly better analgesic efficacy of epidural analgesia when compared with an intravenous pain regimen. A Cochrane systematic review supports this limited superior analgesic effect of epidural analgesia over systemic opioid administration in patients undergoing open aortic surgery, reporting a mean difference in VAS scores on movement on postoperative day 1 of −1.78 (95% CI −2.32 to −1.25) [24]. The clinical relevance of this difference is however debatable.…”

Section: Opioidsmentioning

confidence: 99%

Safety of epidural drugs: a narrative review

Zuylen

Hoope

Bos

et al. 2019

Expert Opinion on Drug Safety

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Introduction: Epidural analgesia is a popular approach to postoperative and labor pain. Neurotoxicity and drug-specific systemic side effects can occur after epidural administration. As an increasing number of epidural drugs are studied and clinically applied, drug efficacy and safety evaluation are crucial. Areas covered: In this narrative review, the authors provide a thorough overview on the safety of the most widely used epidural drugs, focusing on potential neurotoxicity, side effects, and complications in the adult, non-pregnant population. A combined text and MeSH heading search strategy was used to identify relevant publications. Expert opinion: The search for the ideal epidural medication has resulted in a surplus of drug combinations with extensive heterogeneity amongst studies, while the value of investigating these is not always evident. Epidural drugs pose a potential threat of neurotoxicity and other side effects. Consequently, we should pursue safe epidural drug administration to patients and refrain from drugs with minimal proven benefit. Also, studies should compare epidural with systemic application. Because why use a drug epidurally, which can be safely used systemically? Future research should focus on providing solid evidence regarding efficacy of epidural analgesia compared to new and already existing modalities and optimizing presently used medicinal regimens.

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“…Auf der Intensivstation lassen sich periphere und neuroaxiale Regionalanästhesieverfahren sicher anwenden. Insbesondere die Periduralanästhesie führt im Vergleich zur opioidbasierten Schmerztherapie zu einer verbesserten Analgesie, zu weniger pulmonalen [34] und gastrointestinalen Komplikationen und zu einer kürzeren intensivmedizinischen Behandlungs-und Beatmungsdauer [35].…”

Section: Regionalanästhesieunclassified