Impact of epidural analgesia on mortality and morbidity after surgery: Systematic review and meta-analysis of randomized controlled trials

Annals of Surgery

Volumn 259, Issue 6, 2014, Pages 1056-1067

  Pöpping, Daniel M ^a   Elia, Nadia ^b   Van Aken, Hugo K ^a   Marret, Emmanuel ^c   Schug, Stephan A ^d   Kranke, Peter ^e   Wenk, Manuel ^a   Tramèr, Martin R ^f  

^a UNIVERSITY HOSPITAL MÜNSTER   (Germany)

^b UNIVERSITY OF GENEVA   (Switzerland)

^c HÔPITAL TENON   (France)

^d UNIVERSITY OF WESTERN AUSTRALIA   (Australia)

^e UNIVERSITY HOSPITAL WÜRZBURG   (Germany)

^f GENEVA UNIVERSITY HOSPITALS   (Switzerland)

Author keywords

Epidural analgesia; Morbidity; Mortality; Perioperative

Indexed keywords

BUPIVACAINE; BUPRENORPHINE; DIAMORPHINE; FENTANYL; HYDROMORPHONE; KETOBEMIDONE; LIDOCAINE; LOCAL ANESTHETIC AGENT; MORPHINE; NICOMORPHINE; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; OXYCODONE; PARACETAMOL; PENTAZOCINE; PETHIDINE; PIRITRAMIDE; ROPIVACAINE; SUFENTANIL; TRAMADOL;

ARTICLE; ATELECTASIS; DEATH; DEEP VEIN THROMBOSIS; EPIDURAL ABSCESS; EPIDURAL ANESTHESIA; EPIDURAL CATHETER; EPIDURAL HEMATOMA; FOLLOW UP; GENERAL ANESTHESIA; HEART ATRIUM FIBRILLATION; HUMAN; HYPOTENSION; ILEUS; INCIDENCE; INTESTINE FUNCTION; MENINGITIS; META ANALYSIS; MORBIDITY; NEUROLOGICAL COMPLICATION; PATIENT CONTROLLED ANALGESIA; PNEUMONIA; POSTOPERATIVE NAUSEA AND VOMITING; PRIORITY JOURNAL; PRURITUS; RANDOMIZED CONTROLLED TRIAL (TOPIC); RESPIRATION DEPRESSION; RISK FACTOR; SENSITIVITY ANALYSIS; SPINAL CORD INJURY; SUPRAVENTRICULAR TACHYCARDIA; SURGERY; SURGICAL MORTALITY; SYSTEMATIC REVIEW; URINE RETENTION;

ADULT; ANALGESIA, EPIDURAL; HUMANS; MORBIDITY; POSTOPERATIVE COMPLICATIONS; PROGNOSIS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SURGICAL PROCEDURES, OPERATIVE; SURVIVAL RATE; WORLD HEALTH;

EID: 84900815847     PISSN: 00034932     EISSN: 15281140     Source Type: Journal    
DOI: 10.1097/SLA.0000000000000237     Document Type: Article

References (178)

1. Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth. 2011;107:859-868
2. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: A meta-Analysis. JAMA. 2003;290:2455-2463
3. Pöpping DM, Zahn PK, Van Aken HK, et al. Effectiveness and safety of postoperative pain management: A survey of 18 925 consecutive patients between 1998 and 2006: A database analysis of prospectively raised data. Br J Anaesth. 2008;101:832-840
4. Rawal N. Epidural technique for postoperative pain: Gold standard no more?. Reg Anesth Pain Med. 2012;37:310-317
5. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: A meta-Analysis of randomized trials. Br J Anaesth. 2000;84:450-455
6. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: A meta-Analysis. Anesth Analg. 2001;93:853-858
7. Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-Analyses of randomized, controlled trials. Anesth Analg. 1998;86: 598-612
8. Guay J. The benefits of adding epidural analgesia to general anesthesia: A metaanalysis. J Anesth. 2006;20:335-340
9. Popping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: A metaanalysis. Arch Surg. 2008;143:990-999
10. Liu SS, Block BM,Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: A meta-Analysis. Anesthesiology. 2004;101:153-161
11. Svircevic V, Van Dijk D, Nierich AP, et al. Meta-Analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011;114:271-282
12. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000;321:1493
13. McCulloch TJ, Loadsman JA. Reduction of postoperative mortality and morbidity. Little information was given on inclusion criteria. BMJ. 2001;322:1182
14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-Analyses: The PRISMA statement. J Clin Epidemiol. 2009;62:1006-1012
15. Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth. 2001;87:47-61
16. Steinberg RB, Liu SS, Wu CL, et al. Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patientcontrolled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth. 2002;14:571-577
17. Weinbroum AA. Superiority of postoperative epidural over intravenous patient-controlled analgesia in orthopedic oncologic patients. Surgery. 2005;138:869-876
18. Moore RA, GavaghanD, TramerMR, et al. Size is everything-large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain. 1998;78:209-216
19. L'Abbe KA, Detsky AS, O'Rourke K. Meta-Analysis in clinical research. Ann Intern Med. 1987;107:224-233
20. Elia N, Tramer MR. Ketamine and postoperative pain-A quantitative systematic review of randomised trials. Pain. 2005;113:61-70
21. Elia N, Culebras X, Mazza C, et al. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials. Reg Anesth Pain Med. 2008;33:159-167
22. Popping DM, Elia N, Marret E, et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-Analysis of randomized trials. Pain. 2012;153:784-793
23. Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: An overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335-371
24. Casas JP, Chua W, Loukogeorgakis S, et al. Effect of inhibitors of the reninangiotensin system and other antihypertensive drugs on renal outcomes: Systematic review and meta-Analysis. Lancet. 2005;366:2026-2033
25. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13
26. Sharma M, Mehta Y, Sawhney R, et al. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery. Ann Card Anaesth. 2010;13:28-33
27. Caputo M, Alwair H, Rogers CA, et al. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: A prospective, randomized, controlled trial. Anesthesiology. 2011;114:380-390
28. Muehling B, Schelzig H, Steffen P, et al. A prospective randomized trial comparing traditional and fast-Track patient care in elective open infrarenal aneurysm repair. World J Surg. 2009;33:577-585
29. Kilickan L,Gonca S,DalcikC, et al. General anesthesiawith thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2. J Cardiovasc Surg (Torino). 2006;47: 315-322
30. Tenling A, Joachimsson P-, Tyden H, et al. Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery. Effects on pulmonary mechanics. Acta Anaesthesiol Scand. 2000;44:1071-1076
31. Azad SC, Groh J, Beyer A, et al. Continuous peridural analgesia vs patientcontrolled intravenous analgesia for pain therapy after thoracotomy. Anaesthesist. 2000;49:9-17
32. BredtmannRD, Herden HN,TeichmannW, et al. Epidural analgesia in colonic surgery: Results of a randomized prospective study. Br J Surg. 1990;77:638-642
33. Hendolin H, Lahtinen J, Lansimies E, et al. The effect of thoracic epidural analgesia on postoperative stress and morbidity. Ann Chir Gynaecol. 1987;76:234-240
34. Mehta Y, Vats M, Sharma M, et al. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patientswith chronic obstructive pulmonary disease. Ann Card Anaesth. 2010;13:224-230
35. Caputo M, Alwair H, Rogers CA, et al. Myocardial, inflammatory, and stress responses in off-pump coronary artery bypass graft surgery with thoracic epidural anesthesia. Ann Thorac Surg. 2009;87:1119-1126
36. MuehlingBM, HalterG,LangG, et al. Prospective randomized controlled trial to evaluate 'fast-Track' elective open infrarenal aneurysm repair. Langenbecks Arch Surg. 2008;393:281-287
37. Kilickan L, Solak M, Bayindir O. Thoracic epidural anesthesia preserves myocardial function during intraoperative and postoperative period in coronary artery bypass grafting operation. J Cardiovasc Surg (Torino). 2005;46:559-567
38. Gonca S, Kilickan L, Dalcik C, et al. The cardioprotective effects of thoracal epidural anestesia are induced by the expression of vascular endothelial growth factor and inducible nitric oxide synthase in cardiopulmonary bypass surgery. J Cardiovasc Surg (Torino). 2007;48:93-102
39. Tenling A, Joachimsson PO, Tyden H, et al. Thoracic epidural anesthesia as an adjunct to general anesthesia for cardiac surgery: Effects on ventilationperfusion relationships. J Cardiothorac Vasc Anesth. 1999;13:258-264
40. Azad SC, Groh J, Beyer A, et al. Continuous epidural analgesia versus patient controlled intravenous analgesia for postthoracotomy pain. Acute Pain. 2000;3:1-10
41. Bredtmann RD, Kniesel B, Herden HN, et al. The effect of continuous thoracic peridural anesthesia on the pulmonary function of patients undergoing colon surgery. Results of a randomized study of 116 patients. Reg Anaesth. 1991;14:2-8
42. Hendolin H, Lahtinen J, Lansimies E, et al. The effect of thoracic epidural analgesia on respiratory function after cholecystectomy. Acta Anaesthesiol Scand. 1987;31:645-651
43. Hendolin H, Tuppurainen T, Lahtinen J. Thoracic epidural analgesia and deep vein thrombosis in cholecystectomized patients. Acta Chir Scand. 1982;148:405-409
44. El-Refai N, Mandour E. Effect of low-flow sevoflurane anaesthesia combined with epidural block on stress response, hepatic and renal functions in patients undergoing total abdominal hysterectomy. Egypt J Anaesth. 2003;19:155-162
45. Abd El-Hakeem E, Abdel-Aal F. Total intravenous anaesthesia versus thoracic epidural combined with general anaesthesia for thoracic surgery. Egypt J Anaesth. 2004;20:119-125
46. Addison NV, Brear FA, Budd K, et al. Epidural analgesia following cholecystectomy. Br J Surg. 1974;61:850-852
47. AliM,Winter DC, Hanly AM, et al. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth. 2010;104:292-297
48. Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine+fentanyl combination. Eur J Gynaecol Oncol. 2004;25:498-501
49. Bakhtiary F, Therapidis P, Dzemali O, et al. Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: A prospective randomized study. J Thorac Cardiovasc Surg. 2007;134:460-464
50. Barratt SM, Smith RC, Kee AJ, et al. Multimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery. Reg Anesth Pain Med. 2002;27:15-22
51. Barrington MJ, Kluger R, Watson R, et al. Epidural anesthesia for coronary artery bypass surgery comparedwith general anesthesia alone does not reduce biochemical markers of myocardial damage. Anesth Analg. 2005;100:921-928
52. Bauer C, Hentz JG, Ducrocq X, et al. Lung function after lobectomy: A randomized, double-blinded trial comparing thoracic epidural ropivacaine/ufentanil and intravenous morphine for patient-controlled analgesia. Anesth Analg. 2007;105:238-244
53. Behera BK, Puri GD, Ghai B. Patient-controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than intravenous morphine patient-controlled analgesia for early thoracotomy pain. J Postgrad Med. 2008;54:86-90
54. Berendes E, Schmidt C,VanAkenH, et al. Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: A randomized trial. Arch Surg. 2003;138:1283-1290
55. Bew SA, Bryant AE, Desborough JP, et al. Epidural analgesia and arterial reconstructive surgery to the leg: Effects on fibrinolysis and platelet degranulation. Br J Anaesth. 2001;86:230-235
56. Bois S, Couture P, Boudreault D, et al. Epidural analgesia and intravenous patient-controlled analgesia result in similar rates of postoperativemyocardial ischemia after aortic surgery. Anesth Analg. 1997;85:1233-1239
57. Boisseau N, Rabary O, Padovani B, et al. Improvement of 'dynamic analgesia' does not decrease atelectasis after thoracotomy. Br J Anaesth. 2001;87:564-569
58. Boylan JF, Katz J, Kavanagh BP, et al. Epidural bupivacaine-morphine analgesia versus patient-controlled analgesia following abdominal aortic surgery: Analgesic, respiratory, and myocardial effects. Anesthesiology. 1998;89:585-593
59. Brodner G, Van Aken H, Hertle L, et al. Multimodal perioperative management-combining thoracic epidural analgesia, forced mobilization, and oral nutrition-reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg. 2001;92:1594-1600
60. Buggy DJ, DohertyWL, Hart EM, et al. Postoperative wound oxygen tension with epidural or intravenous analgesia: A prospective, randomized, singleblind clinical trial. Anesthesiology. 2002;97:952-958
61. Carli F, Mayo N, Klubien K, et al. Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: Results of a randomized trial. Anesthesiology. 2002;97:540-549
62. Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: A prospective, randomized trial. Dis Colon Rectum. 2001;44:1083-1089
63. Chae BK, Lee HW, Sun K, et al. The effect of combined epidural and light general anesthesia on stress hormones in open heart surgery patients. Surg Today. 1998;28:727-731
64. Cohen BE, Hartman MB, Wade JT, et al. Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia. Spine (Phila Pa 1976). 1997;22:1892-1896
65. Colonna U, Paddeu M, Manani G. Perioperative epidural ropivacaine + morphine vs i.v. tramadol + ketorolac in the treatment of postoperative pain after abdominal surgery. Acta Anaesth Italica. 2001;52:7-15
66. Cullen ML, Staren ED, el-Ganzouri A, et al. Continuous epidural infusion for analgesia after major abdominal operations: A randomized, prospective, double-blind study. Surgery. 1985;98:718-728
67. Dahl JB, Hjortso NC, Stage JG, et al. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy. Reg Anesth. 1994;19:199-205
68. DauriM, Costa F, Servetti S, et al. Combined general and epidural anesthesia with ropivacaine for renal transplantation. Minerva Anestesiol. 2003;69:873-884
69. Davies MJ, Silbert BS, Mooney PJ, et al. Combined epidural and general anaesthesia versus general anaesthesia for abdominal aortic surgery: A prospective randomised trial. Anaesth Intensive Care. 1993;21:790-794
70. De Vries AJ, Mariani MA, Van Der Maaten JM, et al. To ventilate or not after minimally invasive direct coronary artery bypass surgery: The role of epidural anesthesia. J Cardiothorac Vasc Anesth. 2002;16:21-26
71. Della Rocca G, Coccia C, Pompei L, et al. Post-Thoracotomy analgesia: Epidural vs intravenous morphine continuous infusion. Minerva Anestesiol. 2002;68:681-693
72. Doss NW, Ipe J, Crimi T, et al. Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. Anesth Analg. 2001;92:1552-1557
73. Fillinger MP, Yeager MP, Dodds TM, et al. Epidural anesthesia and analgesia: Effects on recovery from cardiac surgery. J Cardiothorac Vasc Anesth. 2002;16:15-20
74. Fisher CG, Belanger L, Gofton EG, et al. Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine (Phila Pa 1976) 2003;28:739-743
75. Garnett RL, MacIntyre A, Lindsay P, et al. Perioperative ischaemia in aortic surgery: Combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia. Can J Anaesth. 1996;43:769-777
76. Garutti I, Quintana B, Olmedilla L, et al.Arterial oxygenation during one-lung ventilation: Combined versus general anesthesia. Anesth Analg. 1999;88:494-499
77. Gelman S, Laws HL, Potzick J, et al. Thoracic epidural vs balanced anesthesia in morbid obesity: An intraoperative and postoperative hemodynamic study. Anesth Analg. 1980;59:902-908
78. George KA, Wright PM, Chisakuta AM, et al. Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery. Acta Anaesthesiol Scand. 1994;38:808-812
79. Gopinathan C, Sockalingham I, Fung MA, et al. A comparative study of patient-controlled epidural diamorphine, subcutaneous diamorphine and an epidural diamorphine/bupivacaine combination for postoperative pain. Eur J Anaesthesiol. 2000;17:189-196
80. Gottschalk A, FreitagM, Tank S, et al. Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery. Anesthesiology. 2004;101:175-180
81. GuptaA, Fant F,AxelssonK, et al. Postoperative analgesia after radical retropubic prostatectomy: A double-blind comparison between low thoracic epidural and patient-controlled intravenous analgesia. Anesthesiology. 2006;105:784-793
82. Hansdottir V, Philip J, Olsen MF, et al. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: A randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology. 2006;104:142-151
83. Heijmans J, Fransen E, Buurman W, et al. Comparison of the modulatory effects of four different fast-Track anesthetic techniques on the inflammatory response to cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2007;21:512-518
84. Hjortso NC, Neumann P, Frosig F, et al. A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery. Acta Anaesthesiol Scand. 1985;29:790-796
85. Hong JY, Lee SJ, Rha KH, et al. Effects of thoracic epidural analgesia combined with general anesthesia on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-Assisted laparoscopic radical prostatectomy. J Endourol. 2009;23:1843-1849
86. Jayr C, Beaussier M, Gustafsson U, et al. Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: Comparative study with i.v. PCA morphine. Br J Anaesth. 1998;81:887-892
87. Jayr C, Thomas H, Rey A, et al. Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology. 1993;78:666-676
88. Jideus L, Joachimsson PO, Stridsberg M, et al. Thoracic epidural anesthesia does not influence the occurrence of postoperative sustained atrial fibrillation. Ann Thorac Surg. 2001;72:65-71
89. Jorgensen H, Fomsgaard JS, Dirks J, et al. Effect of peri-And postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Br J Anaesth. 2001;87:577-583
90. Kammoun W, Mestiri T, Miraoui W, et al. Patient controlled epidural analgesia: Interest in thoracic surgery. Tunis Med. 2008;86:144-149
91. Kataja J. Thoracolumbar epidural anaesthesia and isoflurane to prevent hypertension and tachycardia in patients undergoing abdominal aortic surgery. Eur J Anaesthesiol. 1991;8:427-436
92. Kendall JB, Russell GN, Scawn ND, et al. A prospective, randomised, singleblind pilot study to determine the effect of anaesthetic technique on troponin T release after off-pump coronary artery surgery. Anaesthesia. 2004;59:545-549
93. Kentner R, Heinrichs W, Dick W. Combination of intravenous patientcontrolled analgesia with epidural anesthesia for postoperative pain therapy. Anaesthesiol Reanim. 1996;21:69-75
94. Kim JA, Kim TH, Yang M, et al. Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy?. J Korean Med Sci. 2009;24:930-935
95. Kirov MY, Eremeev AV, Smetkin AA, et al. Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: A randomized, controlled study. BMC Anesthesiol. 2011; 11:17
96. Kunstyr J, Klein A, Lindner J, et al. Use of high-Thoracic epidural analgesia in pulmonary endarterectomy: A randomized feasibility study. Heart Surg Forum. 2008;11:E202-E208
97. Kunstyr J, Stritesky M, Kristof J, et al. Postoperative analgesia in cardiac surgery. Anest Neodkl Pece. 2001;12:191-194
98. Lattermann R, Wykes L, Eberhart L, et al. A randomized controlled trial of the anticatabolic effect of epidural analgesia and hypocaloric glucose. Reg Anesth Pain Med. 2007;32:227-232
99. Levy BF, Scott MJ, Fawcett W, et al. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg. 2011;98:1068-1078
100. Licker M, Spiliopoulos A, Tschopp JM. Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery. Br J Anaesth. 2003;91:525-531
101. Liem TH, Hasenbos MA, Booij LH, et al. Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome. J Cardiothorac Vasc Anesth. 1992;6:156-161
102. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82:1474-1506
103. Logas WG, el-Baz N, el-Ganzouri A, et al. Continuous thoracic epidural analgesia for postoperative pain relief following thoracotomy: A randomized prospective study. Anesthesiology. 1987;67:787-791
104. Loick HM, Schmidt C, Van Aken H, et al. High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg. 1999;88:701-709
105. Lundstrom LH, Nygard E, Hviid LB, et al. The effect of thoracic epidural analgesia on the occurrence of late postoperative hypoxemia in patients undergoing elective coronary bypass surgery: A randomized controlled trial. Chest. 2005;128:1564-1570
106. Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology. 2000;92:433-441
107. Miller L, GertelM, Fox GS, et al. Comparison of effect of narcotic and epidural analgesia on postoperative respiratory function. Am J Surg. 1976;131:291-294
108. Moiniche S, Hjortso NC, Blemmer T, et al. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. Acta Anaesthesiol Scand. 1993;37: 65-69
109. Motamed C, Spencer A, Farhat F, et al. Postoperative hypoxaemia: Continuous extradural infusion of bupivacaine and morphine vs patient-controlled analgesia with intravenous morphine. Br J Anaesth. 1998;80:742-747
110. Neudecker J, Schwenk W, Junghans T, et al. Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg. 1999;86:1292-1295
111. Nishikawa K, Kimura S, Shimodate Y, et al. A comparison of intravenousbased and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. J Anesth. 2007;21:1-6
112. Norris EJ, Beattie C, Perler BA, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology. 2001;95:1054-1067
113. Nygard E, Sorensen LH, Hviid LB, et al. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2004;18:709-714
114. Omar SH, Radwan KG, Youssif MA, et al. A non opioid fast track anesthetic regimen for colonic resection. J Egypt Soc Parasitol. 2009;39:849-864
115. Palermo S, Gastaldo P,Malerbi P, et al. Perioperative analgesia in pulmonary surgery. Minerva Anestesiol. 2005;71:137-146
116. Palomero RodriguezMA, Suarez Gonzalo L, Villar Alvarez F, et al. Thoracic epidural anesthesia decreases C-reactive protein levels in patients undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass. Minerva Anestesiol. 2008;74:619-626
117. Pan LF, Wang DX, Li J. Effects of different methods of anesthesia and analgesia on early postoperative cognitive dysfunction after non-cardiac surgery in the elderly. Beijing Da Xue Xue Bao. 2006;38:510-514
118. Paulsen EK, Porter MG, Helmer SD, et al. Thoracic epidural versus patientcontrolled analgesia in elective bowel resections. Am J Surg. 2001;182:570-577
119. Pflug AE, Murphy TM, Butler SH, et al. The effects of postoperative peridural analgesia on pulmonary therapy and pulmonary complications. Anesthesiology. 1974;41:8-17
120. Priestley MC, Cope L, Halliwell R, et al. Thoracic epidural anesthesia for cardiac surgery: The effects on tracheal intubation time and length of hospital stay. Anesth Analg. 2002;94:275-282
121. Reinhart K, Foehring U,Kersting T, et al. Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship. Anesth Analg. 1989;69:360-369
122. Rigg JR, Jamrozik K, Myles PS, et al. Epidural anaesthesia and analgesia and outcome of major surgery: A randomised trial. Lancet. 2002;359:1276-1282
123. Rimaitis K, Marchertiene I, Pavalkis D. Comparison of two different methods of analgesia. Postoperative course after colorectal cancer surgery. Medicina (Kaunas). 2003;39:129-137
124. Riwar A, Schar B, Grotzinger U. Effect of continuous postoperative analgesia with peridural bupivacaine on intestinal motility following colorectal resection. Helv Chir Acta. 1992;58:729-733
125. Rockemann MG, Seeling W, Goertz AW, et al. Effectiveness, side effects and costs of postoperative pain therapy: Intravenous and epidural patient-controlled analgesia (PCA). Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32:414-419
126. Royse C, Royse A, Soeding P, et al. Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery. Ann Thorac Surg. 2003;75:93-100
127. Ryan P, Schweitzer SA,Woods RJ. Effect of epidural and general anaesthesia compared with general anaesthesia alone in large bowel anastomoses. A prospective study. Eur J Surg. 1992;158:45-49
128. Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiol Scand. 1987;31:161-164
129. Schenk MR, Putzier M, Kugler B, et al. Postoperative analgesia after major spine surgery: Patient-controlled epidural analgesia versus patient-controlled intravenous analgesia. Anesth Analg. 2006;103:1311-1317
130. Schricker T, Meterissian S,Wykes L, et al. Postoperative protein sparing with epidural analgesia and hypocaloric dextrose. Ann Surg. 2004;240:916-921
131. Schulze S, Roikjaer O, Hasselstrom L, et al. Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. Surgery. 1988;103:321-327
132. Schumann R, Shikora S, Weiss JM, et al. A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesth Analg. 2003;96:469-474
133. Scott NB, Turfrey DJ, Ray DA, et al. A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg. 2001;93:528-535
134. Seeling W, Bruckmooser KP, Hufner C, et al. No reduction in postoperative complications by the use of catheterized epidural analgesia following major abdominal surgery. Anaesthesist. 1990;39:33-40
135. Seeling W, Bothner U, Eifert B, et al. Patient-controlled analgesia versus epidural analgesia using bupivacaine or morphine following major abdominal surgery. No difference in postoperative morbidity. Anaesthesist. 1991;40:614-623
136. SenagoreAJ, DelaneyCP, Mekhail N, et al.Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg. 2003;90:1195-1199
137. Senturk M, Ozcan PE, Talu GK, et al. The effects of three different analgesia techniques on long-Term postthoracotomy pain. Anesth Analg. 2002;94:11-15
138. Singelyn FJ, Ferrant T, Malisse MF, et al. Effects of intravenous patientcontrolled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med. 2005;30:452-457
139. Spence AA, Smith G. Postoperative analgesia and lung function: A comparison of morphine with extradural block. Br J Anaesth. 1971;43:144-148
140. Stenseth R, Bjella L, Berg EM, et al. Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery. Eur J Cardiothorac Surg. 1996;10:859-865
141. Susa A, Roveran A, Bocchi A, et al. FastTrack approach to major colorectal surgery. Chir Ital. 2004;56:817-824
142. Svircevic V, Nierich AP, Moons KG, et al. Thoracic epidural anesthesia for cardiac surgery: A randomized trial. Anesthesiology. 2011;114:262-270
143. Taqi A, Hong X, Mistraletti G, et al. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc. 2007;21:247-252
144. Tenenbein PK, Debrouwere R, Maguire D, et al. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anaesth. 2008;55:344-350
145. Tikuisis R, Cicenas S, Miliauskas P, et al. Controlled hypotension in transthoracic esophageal resection. Medicina (Kaunas). 2004;40(suppl 1):174-178
146. Tikuisis R, Miliauskas P, Samalavicius NE, et al. Epidural and general anesthesia versus general anesthesia in radical prostatectomy. Medicina (Kaunas). 2009;45:772-777
147. Tsui SL, Lee DK, Ng KF, et al. Epidural infusion of bupivacaine 0.0625% plus fentanyl 3.3 micrograms/ml provides better postoperative analgesia than patient-controlled analgesia with intravenous morphine after gynaecological laparotomy. Anaesth Intensive Care. 1997;25:476-481
148. Tuman KJ, McCarthy RJ, March RJ, et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg. 1991;73:696-704
149. Turunen P, Carpelan-Holmstrom M, Kairaluoma P, et al. Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: A prospective randomized study. Surg Endosc. 2009;23:31-37
150. Volk T, SchenkM, Voigt K, et al. Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery. Anesth Analg. 2004;98:1086-1092
151. Volk T, DopfmerUR, SchmutzlerM, et al. Stress induced IL-10 does not seem to be essential for early monocyte deactivation following cardiac surgery. Cytokine. 2003;24:237-243
152. Von Dossow V, Welte M, Zaune U, et al. Thoracic epidural anesthesia combined with general anesthesia: The preferred anesthetic technique for thoracic surgery. Anesth Analg. 2001;92:848-854
153. Xue Z, Bai L, Jiang H. Combined epidural block with general anesthesia in patients with chronic obstructive pulmonary disease. J Shanghai Med Univ. 2000;27:302-305
154. Yeager MP, Glass DD, Neff RK, et al. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729-736
155. Yokoyama M, Itano Y, Katayama H, et al. The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy. Anesth Analg. 2005;101:1521-1527
156. Yoshioka M, Mori T, Kobayashi H, et al. The efficacy of epidural analgesia after video-Assisted thoracoscopic surgery: A randomized control study. Ann Thorac Cardiovasc Surg. 2006;12:313-318
157. Zingg U, Miskovic D, HamelCT, et al. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: Benefit with epidural analgesia. Surg Endosc. 2009;23:276-282
158. ZitzelsbergerM, Jauch KW, Sirtl C. Post-Aggression metabolism and peridural anesthesia: Modification of catabolism by anesthesia procedures?. Langenbecks Arch Chir. 1990;375:272-277
159. Zutshi M, Delaney CP, Senagore AJ, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg. 2005;189:268-272
160. Myles PS, Peyton P, Silbert B, et al. Perioperative epidural analgesia
161. Wu CL, Hurley RW, Anderson GF, et al. Effect of postoperative epidural analgesia on morbidity and mortality following surgery inMedicare patients. Reg Anesth Pain Med. 2004;29:525-533
162. Wijeysundera DN, Beattie WS, Austin PC, et al. Epidural anaesthesia and survival after intermediate-To-high risk non-cardiac surgery: A populationbased cohort study. Lancet. 2008;372:562-569
163. Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: Outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004;59:255-261
164. Grafen FC, Neuhaus V, Schob O, et al. Management of acute small bowel obstruction from intestinal adhesions: Indications for laparoscopic surgery in a community teaching hospital. Langenbecks Arch Surg. 2010;395: 57-63
165. Brosi P,Dick F,Do DD, et al.Revascularization for chronic critical lower limb ischemia in octogenarians is worthwhile. J Vasc Surg. 2007;46:1198-1207
166. Melloul E, Egger B, Krueger T, et al. Mortality, complications and loss of pulmonary function after pneumonectomy vs. sleeve lobectomy in patients younger and older than 70 years. Interact Cardiovasc Thorac Surg. 2008;7:986-989
167. Carmona GA, Hoffmeyer P, Herrmann FR, et al. Major lower limb amputations in the elderly observed over ten years: The role of diabetes and peripheral arterial disease. Diabetes Metab. 2005;31:449-454
168. Kanazi GE, Ayoub CM, Aouad M, et al. Subpleural block is less effective than thoracic epidural analgesia for post-Thoracotomy pain: A randomised controlled study. Eur J Anaesthesiol. 2012;29:186-191
169. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: The Framingham. Heart Study. 1998;98:946-952
170. Hulzebos EH, Helders PJ, Favie NJ, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in highrisk patients undergoing CABG surgery: A randomized clinical trial. JAMA. 2006;296:1851-1857
171. Gramigni E, Bracco D, Carli F. Epidural analgesia and postoperative orthostatic haemodynamic changes: Observational study. Eur J Anaesthesiol. 2013;30:398-404
172. Popping DM, Elia N, Wenk M, et al. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-Analysis of randomized trials. Pain. 2013;154:1383-1390
173. Cameron CM, ScottDA,McDonaldWM, et al.Areviewof neuraxial epidural morbidity: Experience of more than 8,000 cases at a single teaching hospital. Anesthesiology. 2007;106:997-1002
174. Christie IW, McCabe S. Major complications of epidural analgesia after surgery: Results of a six-year survey. Anaesthesia. 2007;62:335-341
175. Cook TM, Counsell D, Wildsmith JA, et al. Major complications of central neuraxial block: Report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179-190
176. Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-959
177. Paton L, Jefferson P, Ball DR. The disconnected epidural catheter: A survey of current practice in Scotland. Eur J Anaesthesiol. 2012;29:453-455
178. Volk T, Wolf A, Van Aken H, et al. Incidence of spinal haematoma after epidural puncture: Analysis from the German network for safety in regional anaesthesia. Eur J Anaesthesiol. 2012;29:170-176.