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Invited Critique
October 20, 2008

Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery—Invited Critique

Arch Surg. 2008;143(10):1000. doi:10.1001/archsurg.143.10.1000

Most of us are pretty good at quantifying pain when we should feel it ourselves. But we are often less than perfect when placed in a role of judging and treating another's pain. Familiar explanations for the undertreatment of pain—fear of respiratory depression, ileus, altered mental status, and immobility, to name a few—are front and center when dosing conventional pain therapy.

Pöpping et al have retrospectively reviewed a large group of pain studies comparing intravenous and epidural strategies in patients undergoing major abdominal or thoracic surgical procedures for both adequacy of pain control and the prevention of postoperative pneumonia. They nicely demonstrated the decrease in postoperative pneumonia over the duration of the included study years, regardless of the modality(s) of pain therapy used. But they also show that the use of epidural analgesia for postoperative pain control is associated with a significant decrease in postoperative pneumonia (defined in study) when compared with “conventional” intravenous narcotic use.

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