This review highlights the advantages of regional anaesthesia techniques, especially of
epidural analgesia, for the management of postoperative and posttraumatic
pain: excellent
pain relief and a high degree of patient satisfaction, even compared to the gold standard of
acute pain therapy, i.v. PCA with
opioids. Further advantages of
epidural analgesia (EA) are discussed, such as early recovery of gastrointestinal function, reduction of postoperative respiratory complications, lower incidence of myocardial ischema, better mobilisation, reduced risk of
thromboembolism, lower incidence of
chronic pain problems (such as
phantom limb pain) etc. Nevertheless, many studies failed to show significant effects on outcome (e.g. mortality). Weighing the risks, costs and benefits of EA, this technique is indicated in case of significant
postoperative pain, especially in case of painful mobilisation, in patients with significant pulmonary risk factors (ASA 3 or IV), in patients where an improved perfusion or gastrointestinal motility is deemed essential, and if
chronic pain syndromes are common problems that should be prevented (e.g.,
amputation). For the praxis of
epidural analgesia it is emphasised to place the
catheter in an appropriate segment to obtain sufficient
analgesia without side effects. Organisational structures (such as an acute pain service) and appropriate monitoring allow to continue EA with local anaesthetics and/or
opioids on surgical wards. Recommendations are given for the monitoring of EA on surgical wards. Clear cut agreements should define the role of anaesthesiologists, surgeons and nurses in the management of patients treated with postoperative EA on surgical wards.