Epidural analgesia in sepsis: too early to judge a new concept

Excerpt

Epidural catheters are commonly placed in patients who undergo thoracic or abdominal surgery. In addition to excellent analgesia, epidural infusion of local anaesthetics is associated with a sympathetic block that protects, to some degree, against complications related to surgery and the surgical stress response. These protective effects include increased gastrointestinal blood flow [1], improved tissue oxygenation [2] and a lower incidence of myocardial infarction [3]. In addition, recovery time from surgery is reduced [4]. Because benefits from epidural analgesia are maximal when this technique is used for a prolonged period after surgery, it is recommended to continue epidural analgesia for some days postoperatively. For this reason, intensive care physicians are increasingly confronted with the postoperative use of epidural analgesia, and many have already learned to incorporate this technique into therapeutic strategies to treat critically ill patients. Examples are the prevention or therapy of myocardial ischemia, ileus or splanchnic ischemia, or respiratory dysfunction. …