Post-Surgical Epidural May Boost Survival

By Steven Reinberg
HealthDay Reporter

TUESDAY, Aug. 12 (HealthDay News) — Epidural anesthesia may not only be the best way to control pain after major surgery, it may also improve post-operative survival, Canadian researchers report.

The use of epidural anesthetics for major surgery has been somewhat controversial. There doesn't seem to be much question that it effectively reduces pain, but its safety has caused some concern.

"Using an epidural for pain control after a major operation was safe and actually caused a slightly improved survival for patients who received an epidural," said lead researcher Dr. Duminda Wijeysundera, from Ontario's Institute for Clinical Evaluative Sciences, department of anesthesia, at Toronto General Hospital and the University of Toronto.

People generally have less pain and a lower risk of pneumonia if they use an epidural after a major operation, Wijeysundera said. "But a lot of people are nervous about having an epidural, because it involves a needle and a catheter being placed in their back," he said.

This procedure allows medication to be delivered around the nerves in the epidural space of the spine to prevent pain. Alternative methods of pain control include narcotic pain medication given by injection or via an intravenous line.

The new report was published in the Aug. 11 online edition of The Lancet.

For the study, Wijeysundera's group collected data on more than 259,000 patients who underwent a major noncardiac surgery between 1994 and 2004.

Twenty-two percent of patients received an epidural anesthetic. The researchers found that these people were at a slightly lower risk of dying after 30 days (1.7 percent) compared with patients who had not received an epidural (2.0 percent).

This means that to prevent one death, 477 patients would have to receive an epidural anesthetic, the researchers noted. In the United States, about one million people a year undergo a major operation, Wijeysundera said.

"This study provides reassuring information that epidural anesthetic is safe and may slightly increase the chance of surviving a major operation," Wijeysundera said. "These results may help patients make better informed choices about how they manage their pain after a major operation," he said.

"You need to control post-operative pain," noted one expert, Dr. Zeev N. Kain, chair of the Department of Anesthesiology and Perioperative Care at the University of California, Irvine. "Pain is not good for you, because it hinders your recovery," he said.

The bottom line, Kain said, is that epidurals are safe and should be used but not because of this very slight improvement in survival. He believes that — especially for major procedures — epidurals often relieve pain better than other methods.

"If you have surgeries to remove the pancreas or liver resection or a Whipple procedure, where they take half your abdominal cavity out, these are very painful procedures," Kain said. "For them, there is no question that the best pain relief is epidural," he said.

SOURCES: Duminda Wijeysundera, M.D., Ontario Institute for Clinical Evaluative Sciences, Department of Anesthesia, Toronto General Hospital and University of Toronto, Canada; Zeev N. Kain, M.D., chairman, Department of Anesthesiology and Perioperative Care, University of California, Irvine; Aug. 11, 2008, online edition, The Lancet

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