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[Epidural anesthesia in thoracic and abdominal surgery : Current perspectives and practical implications]
Daniel M Pöpping1, Wiebke Gogarten2
1Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude A1, 48149, Münster, Deutschland. poppind@uni-muenster.de.
Die Anaesthesiologie
|April 8, 2025
Summary
Epidural anesthesia (EA) remains crucial for complex thoracic and abdominal surgeries despite advances in minimally invasive techniques. Alternative pain management strategies offer benefits but EA provides superior pain control and reduced complications in select patient groups.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Surgical Pain Management
Context:
- The evolution of minimally invasive and robot-assisted surgery challenges traditional anesthetic practices.
- Epidural anesthesia (EA) was the standard for thoracic and abdominal procedures, offering superior pain relief and improved recovery.
- Modern surgical trends necessitate a re-evaluation of EA's risk-benefit profile.
Purpose:
- To review the current relevance and indications for epidural anesthesia in thoracic and abdominal surgery.
- To compare EA with alternative pain management strategies like regional blocks and multimodal analgesia.
- To assess the evolving role of EA in contemporary surgical care.
Summary:
- EA provides significant benefits, including superior analgesia, reduced pulmonary complications, and enhanced postoperative mobility.
- Alternative techniques like transversus abdominis plane (TAP) blocks and paravertebral blocks show comparable efficacy with potentially better safety profiles in certain patients.
- EA remains indispensable for extensive thoracic procedures, complex abdominal resections, and high-risk patients prone to severe pain or respiratory compromise.
Impact:
- Highlights the continued importance of EA in specific surgical contexts, particularly complex cases.
- Emphasizes the need for individualized anesthetic planning, balancing EA against emerging alternatives.
- Informs evidence-based strategies for optimizing perioperative pain management and patient outcomes in modern surgery.
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