Analgesia Epidural : primero no dañar . Epidural analgesia : first

The use of epidural analgesia in patients undergoing major abdominal gastrointestinal (GIT) surgery has become routine practice. Multiple, nonrandomised, small trials comparing epidural analgesia to ‘older’ opioid analgesia regimens have produced results that shaped modern practice but are rarely appropriate for modern anaesthesia [1]. Well-structured, randomised controlled trials are few and far between and those that have been performed must be used to guide modern practice [2]. Perceived best practice, influenced by how good the patients look in recovery, is not supported by the evidence to date. Compounding this is a lack of good evidence to accurately assess the complication rate of epidurals [3]. The number needed to treat (NNT) and the number needed to harm (NNH) may be far closer than we think. There is a significant lack of evidence supporting the use of epidural analgesia and we question the routine use of this mode of analgesia in the postoperative period for patients having abdominal surgery. Decisions regarding the use of an epidural in any individual patient, and what we should and should not tell our patients, need to be framed from the best evidence available and not the most evidence available.

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