Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in
postoperative pain management. However, newer, evidence-based outcome data show that the benefits of
epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic
epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional
analgesic techniques are as effective as
epidural analgesia. These include paravertebral block for
thoracotomy, femoral block for total hip and
knee arthroplasty,
wound catheter infusions for cesarean delivery, and local infiltration
analgesia techniques for lower limb joint
arthroplasty.
Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other
surgical procedures. Although
pain relief associated with
epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of
epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative
analgesia, epidural analgesia may no longer be considered the gold standard.