Postoperative thoracic epidural anesthesia in gastrointestinal surgery: Outcomes, quality of Life, and current controversies

Introduction: Quality of Life (QoL) may be reduced by postoperative pain and improving analgesic techniques, including local and regional techniques, may impact on this important healthcare measurement. This study focused on the QoL issues surrounding thoracic epidural analgesia used in patients undergoing gastrointestinal surgery. Methods: A review of the published literature (English language, electronic search) was undertaken using the terms: quality of life, analgesia, epidural, thoracic epidural, regional anesthesia, gastrointestinal surgery, colon and rectal surgery, abdominal surgery, major surgery, complications, pain scores. There were no exclusions and all relevant literature was included in the breadth of discussion. Results: Epidural analgesia may improve pain, sedation scores, pulmonary function, tissue oxygenation, and QoL but there may be little impact on overall patient morbidity and mortality. The relative paucity of data and diminutive power of many clinical studies represent a challenge to establishing superiority or equivalence of epidurals over patient-controlled opiate analgesia but emerging evidence suggests an improved QoL, perhaps through less sedation and faster recovery of gastrointestinal function. Conclusions: The benefits of postoperative thoracic epidural analgesia include better analgesia and overall well-being in addition to the intuitive advantages of less sedation and improved pulmonary function following gastrointestinal surgery.