Postoperative analgesia for thoraco-abdominal surgery – where is the evidence?

Major thoracic and abdominal surgery causes significant postoperative pain and other morbidity. Neuraxial regional anaesthesia/analgesia (RA) provides a quality of postoperative analgesia that is superior to systemic opioids and reduces the risks of specific postoperative morbidity indicators (reduction in blood loss, reduced risk of thrombo-embolic events, reduction in duration of ileus, avoidance of opioid side-effects). Effective analgesia, per se, will not change surgical outcome; a postoperative epidural will have no long lasting benefits, except lower pain scores, unless the analgesia provided is used to achieve specific targets – accelerated rehabilitation, early return to oral nutrition etc. In addition, there are independent variables that directly affect outcome and these need to be incorporated with the benefits of RA to improve overall outcome