An epidural for pain relief around the time of surgery is safe, a new study confirms, but it has little or no beneficial impact on survival after surgery.The new study suggests that an epidural should not be used for the goal of improving survival, Dr. Duminda N. Wijeysundera, from the University of Toronto, and colleagues conclude. However, because the strategy is safe, it's a valid treatment for other indications, such as improving pain relief and preventing lung complications.
Epidurals involve injecting a local anesthetic into the lower spine, and they are considered the most effective form of pain relief following certain types of surgery such as procedures done in the chest or abdominal cavities. Epidurals offer better post-surgery pain relief than intravenous opioid drugs and also reduce the "surgical stress response," which may have benefits for the heart and lungs, the study team notes.
To investigate the impact of an epidural on survival, the study team examined data on roughly 259,000 patients who had intermediate to high-risk non-cardiac surgery from April 1994 through March 2004 in Ontario, Canada.
Overall, 22 percent of the patients received an epidural in the "perioperative" period -- that is, the period of time extending from when the patient goes into the hospital, clinic, or doctor's office for surgery until the time the patient is discharged home.
According to Wijeysundera and colleagues, receiving an epidural was associated with a small reduction in death at 30 days. The death rate was 1.7 percent in patients who received an epidural versus 2.0 percent in those who did not.
Put another way, 477 patients had to have an epidural to avert one death, the study team notes in The Lancet medical journal.
In a commentary published with the study, anesthesiologists Dr. Michael J. Barrington and Dr. David A. Scott, note that "provision of effective analgesia 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 analgesia," Barrington and Scott add.
SOURCE: The Lancet, August 11, 2008.
Epidurals involve injecting a local anesthetic into the lower spine, and they are considered the most effective form of pain relief following certain types of surgery such as procedures done in the chest or abdominal cavities. Epidurals offer better post-surgery pain relief than intravenous opioid drugs and also reduce the "surgical stress response," which may have benefits for the heart and lungs, the study team notes.
To investigate the impact of an epidural on survival, the study team examined data on roughly 259,000 patients who had intermediate to high-risk non-cardiac surgery from April 1994 through March 2004 in Ontario, Canada.
Overall, 22 percent of the patients received an epidural in the "perioperative" period -- that is, the period of time extending from when the patient goes into the hospital, clinic, or doctor's office for surgery until the time the patient is discharged home.
According to Wijeysundera and colleagues, receiving an epidural was associated with a small reduction in death at 30 days. The death rate was 1.7 percent in patients who received an epidural versus 2.0 percent in those who did not.
Put another way, 477 patients had to have an epidural to avert one death, the study team notes in The Lancet medical journal.
In a commentary published with the study, anesthesiologists Dr. Michael J. Barrington and Dr. David A. Scott, note that "provision of effective analgesia 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 analgesia," Barrington and Scott add.
SOURCE: The Lancet, August 11, 2008.
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