The Pros And Cons Of Epidural Anesthesia

Epidural anesthesia is preferred by some clinicians. Epidural anesthesia and analgesia requires placing a specially designed needle (Hustead, Tuohy, or Crawford) into the epidural space. Drugs may be injected directly through the needle or an epidural catheter may be inserted. Subsequent postoperative analgesia may utilize continuous drug infusion or injection of a single drug. A variety of other agents have been added to epidural infusions Epinephrine can induce a synergistic analgesic on the spinal cord as well as elicit vasoconstriction on the blood vessels for decreased absorption of local anesthetic36. Other multimodal approaches have utilized small doses of ketamine, an NMDA antagonist in the spinal cord, for sensory blockade and prevention of central sensitization of nociceptors37.
Patients given a single epidural injection of extended-release epidural morphine (EREM) have demonstrated a 48 hour period of analgesia39.
Patients given EREM in clinical trials after hip replacement had significant less supplemental opioid requirement after surgery than placebo39. Furthermore, the needs for rescue medications were minimal with less instances of hypotension. Other potential advantages of EREM include no epidural catheter or pump related issues which can create gaps in analgesia postoperatively. The absence of epidural and patient controlled analgesia pump technology theoretically reduces opportunities for medication errors and pump programming errors as well. The side effects of EREM are similar to other opioids including nausea, vomiting, constipation, and respiratory depressions. Ideally, the use of EREM in a multimodal analgesic approach and with appropriate patient selection may result in analgesia without the need for any tethering pump
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The benefits of epidural analgesia and surgical outcomes have been well documented in the literature38. Compared with parenteral opioid use after surgery, the utilization of continuous infusion with epidural analgesia provides superior relief in post-operative pain with few adverse outcomes. The limitations of epidural analgesia often involve failed or dislodged catheters, unilateral blocks, and incompatibility in patients who are anti-coagulated. There is a risk of spinal hematomas with patients who are receiving anti-coagulation with an indwelling epidural catheter. Other limitations related to local anesthetics include hypotension and motor impairment in these patients.