Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/47102
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Type: Journal article
Title: Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patients
Author: Peyton, P.
Myles, P.
Silbert, B.
Rigg, J.
Jamrozik, K.
Parsons, R.
Citation: Anesthesia and Analgesia, 2003; 96(2):548-554
Publisher: Lippincott Williams & Wilkins
Issue Date: 2003
ISSN: 0003-2999
Statement of
Responsibility: 
Philip J. Peyton, Paul S. Myles, Brendan S. Silbert, John A. Rigg, Konrad Jamrozik, and Richard Parsons
Abstract: In a primary analysis of a large recently completed randomized trial in 915 high-risk patients undergoing major abdominal surgery, we found no difference in outcome between patients receiving perioperative epidural analgesia and those receiving IV opioids, apart from the incidence of respiratory failure. Therefore, we performed a selected number of predetermined subgroup analyses to identify specific types of patients who may have derived benefit from epidural analgesia. We found no difference in outcome between epidural and control groups in subgroups at increased risk of respiratory or cardiac complications or undergoing aortic surgery, nor in a subgroup with failed epidural block (all P > 0.05). There was a small reduction in the duration of postoperative ventilation (geometric mean [SD]: control group, 0.3 [6.5] h, versus epidural group, 0.2 [4.8] h; P = 0.048). No differences were found in length of stay in intensive care or in the hospital. There was no relationship between frequency of use of epidural analgesia in routine practice outside the trial and benefit from epidural analgesia in the trial. We found no evidence that perioperative epidural analgesia significantly influences major morbidity or mortality after major abdominal surgery. IMPLICATIONS: Secondary analysis of data from a large randomized trial of perioperative epidural analgesia demonstrates no beneficial effect on major postsurgical morbidity or mortality from epidural analgesia.
Rights: Copyright © 2003 International Anesthesia Research Society
RMID: 0020081422
DOI: 10.1213/01.ANE.0000043441.00059.FA
Published version: http://www.anesthesia-analgesia.org/cgi/content/abstract/96/2/548
Appears in Collections:Public Health publications

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