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Title: Epidural Safe for Postoperative Pain, Little Effect on Survival
URL: http://www.pslgroup.com/dg/2280E6.htm
Doctor's Guide
August 11, 2008

NEW YORK -- August 11, 2008 -- Epidural anaesthesia/analgaesia (EA) is safe for patients undergoing intermediate- to high-risk surgery other than cardiac surgery, but only increases survival slightly compared with those who do not receive it, according to a study published early online and in an upcoming edition of The Lancet.

Duminda Wijeysundera, MD, Institute for Clinical Evaluative Sciences, Department of Anaesthesia, Toronto General Hospital and University of Toronto, Toronto, Ontario, and colleagues did a retrospective study of 259,037 patients to investigate if the benefits of EA translated into improved survival for the patients who receive it.

The patients in the study were all aged 40 years or older and had elective intermediate- to high-risk noncardiac surgery between 1994 and 2004. A total of 56,556 (22%) of these patients received EA, and the procedure was associated with a small reduction in 30-day mortality (1.7%) compared with patients who did not receive EA (2.0%). In other words, 477 patients had to have had EA to avert 1 death.

"Epidural anaesthesia was associated with a small improvement in 30-day survival, but this effect should be interpreted cautiously. The estimate had borderline significance despite a large sample size. Its absolute magnitude was also small, corresponding to a number needed to treat of 477," the authors wrote.

"Our study, therefore, does not provide compelling evidence that epidural anaesthesia improves postoperative survival. Nonetheless, our results support the safety of perioperative epidural anaesthesia when used for indications other than improving survival, for example, improving postoperative pain relief or preventing postoperative lung complications."

In an accompanying comment, Drs. Michael Barrington and David Scott, Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia, said, "Wijeysundera and colleagues point out that our focus should be on the proven benefits of epidural analgaesia. The most durable and clearly defined benefit of epidural analgaesia is improved analgaesia.

"Provision of effective analgaesia is our core business. It has substantial physiological and psychological benefits and is regarded as a fundamental human right. Pain after major surgery can be severe, and we think that in many cases pain relief alone is an unambiguous clinical indication for postoperative epidural analgaesia."


SOURCE: The Lancet

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