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Epidural anaesthesia and analgesia for surgery: still going strong?

机译：硬膜外麻醉和镇痛用于外科手术：仍然很牢固吗？

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The discussion on the value of epidural anaesthesia and analgesia for surgery is fuelled by current controversies regarding effects on postoperative morbidity and mortality, potential benefits for outcome and the fear of rare, but catastrophic neurological complications. This review of the most recent publications on the topic since April 2002 illustrates some of the aspects contributing to the ongoing discussion.In contradiction to previous meta-analyses, recent trials could not demonstrate significant improvements of overall morbidity or mortality by epidural anaesthesia and analgesia. However, the technique was shown again to provide superior analgesia and a reduction of perioperative stress response and respiratory complications. Analysis of the current literature strongly supports that epidural anaesthesia and analgesia remains a safe practice with a low rate of severe complications, in particular in paediatric surgery. Several developments in equipment, techniques and especially drugs have been reported, resulting in improved balanced anaesthesia and analgesia and contributing to the safety of this technique.In an era of evidence-based medicine, further meta-analyses and well-planned large randomized trials have to address the controversial issues of epidural anaesthesia and analgesia and postoperative outcome. In the context of a more holistic 'rehabilitative' management of the perioperative period, this technique might well represent a key factor to improve outcome, reduce hospital stay and thereby healthcare costs. Recent innovations and developments in techniques and drugs as well as established guidelines should further minimize potential errors and harmful complications.
机译：当前关于对术后发病率和死亡率的影响，对结局的潜在益处以及对罕见的但灾难性神经系统并发症的恐惧的争议引发了关于硬膜外麻醉和镇痛在外科手术中的价值的讨论。自2002年4月以来对这一主题的最新出版物的回顾说明了正在进行的讨论的某些方面。与以前的荟萃分析相反，最近的试验未能证明硬膜外麻醉和镇痛能显着改善总体发病率或死亡率。但是，再次证明该技术可提供出色的镇痛效果，并减少围手术期的应激反应和呼吸系统并发症。对现有文献的分析有力地支持了硬膜外麻醉和镇痛仍然是一种安全的方法，严重并发症的发生率较低，尤其是在儿科手术中。据报道，设备，技术特别是药物方面的一些发展，改善了麻醉和镇痛的平衡性，并为该技术的安全性做出了贡献。在循证医学时代，进一步的荟萃分析和精心策划的大型随机试验已经开展解决有争议的硬膜外麻醉和镇痛以及术后结果的问题。在围手术期更全面的“康复”管理的背景下，该技术可能很好地代表了改善预后，减少住院时间并从而降低医疗成本的关键因素。技术和药物的最新创新和发展以及既定的准则应进一步减少潜在的错误和有害并发症。

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