Role of Epidural Anaesthesia and Analgesia in Reducing Postoperative Morbidity and Mortality During Major Abdominal Surgery

Abstract

Three hundred sixty six adult patients scheduled for major abdominal surgery were randomized to receive either general anaesthesia with postoperative parenteral analgesia (Group GA, n=187) or combined general and epidural anaesthesia with postoperative epidural analgesia (Group CEGA, n=179). Aim of the study was to determine whether epidural anaesthesia and analgesia could reduce the incidence of death and major post-operative complications. Overall there was no significant difference in the incidence of mortality and major morbidity between the two groups except that the respiratory complications were significantly reduced in CEGA group (P< 0.05). 11 (5.88%)& 7 (3.9%) patients died in the groups GA and CEGA respectively during hospital stay (P>0.05). Pain relief was signifi-cantly better in CEGA group with cumulative pain scores being less in CEGA group (P< 0.001). Mean time of ileus was slightly shorter in CEGA group but time of first oral intake& bowel movement as well as length of hospital stay was same in two groups. It was concluded that although the incidence of mortality and all the major morbidities were not reduced by epidural anaesthesia& analgesia, the better pain control and significant reduction in respiratory complications justify the use of epidural analgesia in patients who are expected to have severe pain& may develop postoperative respiratory complications.