rca Revista Colombiana de Anestesiología Rev. colomb. anestesiol. 0120-3347 SCARE-Sociedad Colombiana de Anestesiología y Reanimación 10.1097/CJ9.0000000000000033 00016 Images Epidural analgesia in abdominal major surgery: pros, cons, and unresolved issues beyond pain control Analgesia epidural en cirugía abdominal mayor: pros, contras y puntos sin resolver mas allá del control del dolor Ariza Fredy a b c * Rodriguez-Mayoral Hector b Villarreal Karen b Universidad ICESI, Cali, Colombia Universidad ICESI Cali Colombia Universidad ICESI, Cali, Colombia Universidad ICESI Cali Colombia Universidad del Valle, Cali, Colombia Universidad del Valle Universidad del Valle Cali Colombia Universidad del Valle, Cali, Colombia Universidad del Valle Universidad del Valle Cali Colombia Universidad del Valle, Cali, Colombia Universidad del Valle Universidad del Valle Cali Colombia Fundación Valle del Lili, Cali, Colombia. Fundación Valle del Lili Cali Colombia Correspondence: Fundación Valle del Lili, Av, Simón Bolivar, Cra. 98 No 18-49, Cali, 760032, Colombia. E-mail: fredyariza@hotmail.com Apr-Jun 2018 46 2 175 176 This is an open-access article distributed under the terms of the Creative Commons Attribution License Keywords: Analgesia Epidural Pain Morbidity Acute Pain Image Palabras clave: Analgesia Epidural Dolor Morbilidad Dolor agudo Imágenes

Epidural analgesia (EPA) is a recognized approach to pain control that is used in approximately 50% to 60% of all abdominal major surgeries around the world. It constitutes an important issue among strategies of multimodal postoperative analgesia, due to its potential to improve rehabilitation, low rate of complications, and high satisfaction reported by patients.1,2

Worldwide trends to use epidural catheters at high spinal levels (usually T6-T8) and new delivery systems that provide pain rescue modalities added to classic continuous infusions have the potential to reducing the rates of related adverse events (uncontrolled pain, motor block, and urinary retention).3 Besides recognized advantages of EPA based on moderate to strong evidence, there are detractors who warn on a potential increase of intestinal leakage, but available information is of low/doubt quality and recent related papers have not found any association.4,5

Hypotension remains as a big problem related to EPA and future research must focus on strategies to prevent it. Acute pain management services play a key role to implementation of standardized protocols of EPA in order to reduce postoperative morbidity and improve quality and safety (Fig. 1).

Impact of epidural analgesia for major surgery on perioperative outcomes and recommended puncture levels for different procedures. Source: Authors.

Ethical disclosures

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.

Right to privacy and informed consent. The authors declare that no patient data appear in this article.

 References 1. Popping D, Elia N, Van Aken H, et al. Impact of epidural analgesia on mortality and morbidity after surgery. Systematic review and meta-analysis of randomized controlled trials. Ann Surg 2014;259:1056-1067. Popping D Elia N Van Aken H Impact of epidural analgesia on mortality and morbidity after surgery Systematic review and meta-analysis of randomized controlled trials Ann Surg 2014 259 1056 1067 2. Guay J, Nishimori M, Koop S. Epidural local anesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting, and pain after abdominal surgery: a Cochrane review. Anesth Analg 2016;123:1591-1602. Guay J Nishimori M Koop S Epidural local anesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting, and pain after abdominal surgery a Cochrane review Anesth Analg 2016 123 1591 1602 3. Ahmed A, Latif N, Khan R. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital. J Anaesthesiol Clin Pharmacol 2013; 29:472-477. Ahmed A Latif N Khan R Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital J Anaesthesiol Clin Pharmacol 2013 29 472 477 4. Piccioni F, Mariani L, Negri M, et al. Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer: a retrospective study on 1,474 patients. J Surg Oncol 2015;112:225-230. Piccioni F Mariani L Negri M Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer a retrospective study on 1,474 patients J Surg Oncol 2015 112 225 230 5. Wang W, Zhao G, Wu L, et al. Risk factors for anastomotic leakage following esophagectomy: impact of thoracic epidural analgesia. J Surg Oncol 2017;116:164-171. Wang W Zhao G Wu L Risk factors for anastomotic leakage following esophagectomy impact of thoracic epidural analgesia J Surg Oncol 2017 116 164 171

Ariza F, Rodriguez-Mayoral H, Villarreal K. Epidural analgesia in abdominal major surgery: pros, cons, and unresolved issues beyond pain control. Rev Colomb Anestesiol. 2018;46:175-176.

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Authors declare no conflicts of interest implied in the writing of this manuscript.