Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion

Post-operative ileus constitutes a major morbidity after abdominal surgery. While systemic opioid analgesia is thought to interfere with gastrointestinal function, epidural anaesthesia and analgesia can theoretically speed resolution of ileus. This chapter reviews the pathophysiology of post-operative ileus and the experimental and clinical literature which investigates the effects of epidural therapy on gastrointestinal motility and blood flow. The risks of epidural therapy, including the potential stress on fresh colonic anastomoses, are also discussed. Emphasis is placed on the inclusion of local anaesthetics in the epidural analgesic solution and on the vertebral level of epidural catheter placement. Epidural anaesthesia–analgesia targeted to the thoracic and high lumbar spine congruent to the abdominal incision appears to shorten the duration of ileus after abdominal surgery without undue risk to the patient. However, length of hospital stay is not decreased unless fast-track management is implemented.