Abstract

CABA, F.. Should epidural analgesia still be a routine technique in pain units?. Rev. Soc. Esp. Dolor [online]. 2010, vol.17, n.4, pp.206-212. ISSN 1134-8046.

Epidural analgesia has become a routine process in the peri-operative management of surgical patients which has been extended from the operating rooms and high dependency units to hospital wards. The irruption into this new scenario has improved post-surgical analgesia with acceptable safety margins, and has secured a predominant place in the analgesia guidelines of Acute Pain Units (APU). Epidural analgesia with local anaesthetics and opioids, compared to systemic with opioids, has historically been more effective, with a decrease in complications due to the reduction in surgical stress and the improved cardiorespiratory function. However, as well as these these advantages, epidural analgesia also has some disadvantages such as lowering of blood pressure or urinary retention, along with potentially serious ones arising from neurological damage caused by epidural haematoma, infection or direct injury of the nerve tissue. Although its advantages have been consistent and solid, it does seem to be the case today. The advances made in minimally invasive surgery, with earlier hospital discharge, together with multimodal strategies, are leading to the re-establishment of the use of techniques such as epidural and a re-evaluation of its indications. The latest evidence leads us to believe that epidural analgesia has reached its limit in the treatment of post-surgical pain and will begin to lose ground with the introduction of equally effective techniques, with less complications and secondary effects. This will be a slow process in which it must be assured that the alternative analgesics really give better results as regards efficacy, safety, tolerability and quality of recovery from the perspective of the patient.

Keywords : Epidural analgesia; Postoperative pain; Acute pain units.

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