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Strategies to Reduce Postoperative Pulmonary Complications after Noncardiothoracic Surgery
Submit responseDr. Lawrence and colleagues (1) write that “Evidence on intraoperative epidural anesthesia and postoperative epidural analgesia is insufficient”. However, they affirm that “Good evidence suggests that lung expansion therapy reduces postoperative pulmonary risk after abdominal surgery”.
The use of postoperative lung expansion therapy (incentive spirometry, deep breathing exercises, and continuous positive airway pressure) may be very difficult because of pain. Epidural analgesia has been shown to reduce postoperative pain, improve gastrointestinal function and reduce the incidence of serious complications (2,3).
The authors state that the risk for epidural bleeding due to postoperative epidural catheters may influence decisions about modalities for pain control and thromboembolism prophylaxis. They don’t consider that epidural analgesia permits early mobilization programmes, avoiding immobility.
In our hospital anesthesiologists provide critical care for surgical patients; the use of epidural analgesia provides them safe analgesia, avoiding opioids which are known to produce ileus and ease development of hyperalgesia (4).
If the authors haven’t found evidence that epidural analgesia reduces postoperative pulmonary complications, they must admit that epidural analgesia does reduce pain, allowing lung expansion therapies and early mobilization programmes which have shown to reduce length of hospital stay (5).
1. Lawrence VA, Cornell JE, Smetana GW. Strategies To Reduce Postoperative Pulmonary Complications after Noncardiothoracic Surgery: Systematic Review for the American College of Physicians. Ann Intern Med. 2006;144:596-608. [PMID:16618957]
2. Carli F, Mayo N, Klubien K, Schricker T, Trudel J, Belliveau P. Epidural analgesia enhances functional exercise capacity and health- related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 2002;97:540–549. [PMID:12218518]
3. Rodgers A, Walker N, Schug S,McKee A, KehletH, van Zundert A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493. [PMID: 11118174]
4. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104:570-87. [PMID:16508405]
5. Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg. 2003;90:1497-504. [PMID:14648727]
Conflict of Interest:
None declared