Weiss Raphael, Pöpping Daniel M
University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, Münster, NRW, Germany.
Curr Opin Anaesthesiol. 2018 Oct;31(5):622-629. doi: 10.1097/ACO.0000000000000640.
Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications.
In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmias and pneumonia. When it is embedded into a multimodal fast-track program, it also shortens intensive care and hospital stay.
TEA provides superior pain control with a handful of important advantages if used sensibly and with caution. Because of associated risks for severe neurological complications, clear contraindications should be ruled out. Special attention needs be paid to potential hypotension in the setting of epidural analgesia. If these key points are considered, a TEA still represents a viable option for enhanced recovery after major abdominal surgery.
尽管在重大腹部手术的多模式镇痛中，胸段硬膜外镇痛（TEA）常被视为金标准，但由于其潜在的严重并发症，对于它是否仍是促进康复的可行选择，目前仍存在争议。
除了无与伦比的镇痛效果外，TEA还有其他几个优点。研究表明，TEA对围手术期发病率和死亡率、肠功能、肠梗阻的发生以及患者活动能力都有积极影响。此外，TEA可以减少阿片类药物引起的副作用、心律失常和肺炎。当它被纳入多模式快速康复计划时，还能缩短重症监护时间和住院时间。
如果合理且谨慎使用，TEA能提供卓越的疼痛控制，并具有一些重要优势。由于存在严重神经并发症的相关风险，应排除明确的禁忌症。在硬膜外镇痛的情况下，需要特别注意潜在的低血压。如果考虑到这些关键点，TEA仍然是重大腹部手术后促进康复的可行选择。
