Does thoracic epidural analgesia improve outcome after lung transplantation?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of preoperative or early postoperative thoracic epidural analgesia (TEA) is effective in improving outcomes--reducing duration of mechanical ventilation, intensive care unit (ICU) length of stay and respiratory complications--in patients undergoing lung transplantation (LTx). Of the 42 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, four out of the five retrieved studies clearly supported the use of TEA as the cornerstone of a multi-faceted strategy for improving outcomes after LTx. Indeed, the interest and benefit was shown not only in terms of duration of mechanical ventilation, but also in reducing the ICU length of stay and the number of respiratory complications. Hence, current evidence suggests TEA to be safe and effective in alleviating postoperative pain and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome after LTx. However, given the low level of evidence of published studies, prospective trials are warranted to confirm those encouraging results.