Pain relief. Epidural analgesia is the Rolls Royce of postoperative pain relief for surgery where it is indicated. It can be done for all surgery on the chest, abdomen and legs, but not on the neck, arms and head (this would involve an epidural effect that goes too high, with which it is impossible to breathe or maintain a normal blood pressure and heart rate). Since the local anaesthetic in the epidural space blocks the nerves when they enter (and leave) the spinal cord, all pain and sensation can be taken away, even during movement and coughing.
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The big difference with morphine and other painkillers that are administered systemically, i.e. orally, intravenously, intramuscularly, or rectally (they go to “the whole system”), is that with the systemically administered painkillers the pain relief can never be complete. Pain receptors in the brain and tissues are blocked, but not the nerves conducting the pain impulse to the spinal cord and brain. Systemic painkillers therefore rarely allow patients to be pain free when the pain is severe, like during physiotherapy, movement or coughing.
Easier breathing. Because the pain relief is so complete, breathing and coughing are completely or almost completely void of pain. This allows for better expansion of the lungs, better uptake of oxygen, and better coughing up of secretions, which is especially important for smokers. Overall, it leads to decreased risk for pneumonia.
Less stress on the heart. Pain increases heart rate and blood pressure, which can be harmful to patients with a poor heart and even lead to heart attacks. Perfect pain relief with an epidural can therefore decrease the risk for cardiac complications post-operatively.
Earlier feeding. The local anaesthetic in the epidural infusion allows the bowel to contract better. Systemically administered morphine (via intravenous or intramuscular injection) paralyses the bowel, and this can be avoided almost completely if epidural pain relief is used. Patients can therefore eat already the day after surgery, even after abdominal operations (i.e. surgery on the intestines).
Decreased risk for deep venous thrombosis (DVT). Major surgery, and especially orthopaedic surgery, predisposes for formation of blood clots in the legs or pelvis, which can shoot up to the lungs and be fatal. Epidural analgesia decreases the risk for this complication by 30%.
Decrease in general stress response. Surgery subjects your body to a lot of stress. With this is not meant the stress that is spoken about in daily life, like living in a hectic world, sitting in traffic jams, being yelled at by an irritating boss etc. What is meant here is physiological stress: pain, cooling during surgery, blood loss etc. If all these stressing factors are treated appropriately, the challenge (“stress”) to the body will be much less, allowing for a speedier and less complicated recovery. For example: the stress of pain increases your heart rate and blood pressure, and in a person with heart disease, this can lead to a heart attack.
Decreased incidence in chronic pain. Poorly treated pain after surgery can sometimes become chronic (lasting several months or years). This has been described for chest surgery, but might also be true for other types of surgery.
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