Epidural Anesthesia and Analgesia in High-risk Surgical Patients

TLDR

The study randomized high‑risk surgical patients to receive epidural anesthesia and analgesia (EAA) versus standard care to assess its impact on postoperative morbidity. Fifty‑three patients were enrolled, with 28 assigned to EAA and 25 to standard anesthetic and analgesic techniques. EAA lowered overall postoperative complications (P = 0.002), cardiovascular failure (P = 0.007), major infections (P = 0.007), urinary cortisol excretion (P = 0.025), and hospital costs (P = 0.02), demonstrating a significant benefit for high‑risk surgical patients.

Abstract

The authors conducted a randomized controlled clinical trial to evaluate the effect of epidural anesthesia and postoperative analgesia (EAA) on postoperative morbidity in a group of high-risk surgical patients. A total of 53 patients were admitted to the study, 28 received EAA, and 25 received standard anesthetic and analgesic techniques without EAA. Surgical "risk" was evaluated preoperatively and found to be comparable in the two groups. When compared to control patients, patients who received EAA had a reduction in the overall postoperative complication rate (P = 0.002) and in the incidence of cardiovascular failure (P = 0.007) and major infectious complications (P = 0.007). Urinary cortisol excretion, a marker of the stress response, was significantly diminished during the first 24 postoperative hours in the group receiving EAA (P = 0.025). Finally, hospital costs were significantly reduced for patients who received EAA (P = 0.02). The authors conclude that EAA exerted a significant beneficial effect on operative outcome in a group of high risk surgical patients.