Is epidural analgesia the best way to manage post-operative pain?

Is epidural analgesia the best way to manage post-operative pain? What do you think?

Epidural analgesia has been shown to be an effective method of controlling post-operative pain after many different types of surgery. Level one evidence (systematic reviews) is available showing that epidural analgesia provides better post-operative pain relief than parenteral opioids such as morphine patient controlled analgesia systems (PCA) and subcutaneous or intramuscular morphine injections in major surgery in the thoracic abdominal and pelvic areas as well as orthopaedic and vascular surgery to the lower limbs. As well as providing better pain relief, epidural analgesia has also been shown to reduce post-operative complications such as incidence of respiratory failure, cardiovascular complications, gastrointestinal complications, renal insufficiency and the need for intubation and ventilation.

However, the use of epidural analgesia is not without risks. Problems relating to the drugs used (usually a local anaesthetic and/or an opioid) and the placement of a catheter into the epidural space need to be considered.

An anaesthetist will assess the benefits and risks of using epidural analgesia on an individual basis and will only place an epidural catheter if the benefits outweigh the risks.

It is also important that a patient receiving epidural analgesia is adequately monitored by nurses that are suitably trained to recognised, and respond promptly to, signs of the potentially life threatening complications of epidural analgesia.

In summary, epidural analgesia is the best way to manage post-operative pain when the benefits outweigh the potential risks and monitoring by suitably trained staff is available. What do you think?

Andrew Bird is a Nurse Specialist at the Pain Management Service.