As any 38-weeker 7 cm dilated with contractions q4min can tell you….epidurals rock. What hasn’t been as obvious in clinical practice and in the literature, is their effects in the general surgical population. The blunting of the sympathetic response, opiod-sparing effect and earlier return of bowel function have been well documented. This month an article in Anesthesiology provides an interesting observation about the slinky plastic catheter:
Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer Recurrence: A Retrospective Analysis
We evaluated cancer recurrence in men undergoing radical prostatectomy. After adjustment for confounding factors, patients who received general anesthesia combined with epidural analgesia had a 57% (95% CI, 17-78%) lower risk of cancer recurrence than patients who had general anesthesia and postoperative opioids. A propensity-matched analysis on a subset of the data gave a similar result: Epidural analgesia had a 52% (95% CI, 0-77%) lower risk of cancer recurrence.
While this study had some notable limitations, the potential benefit in outcomes is darn compelling.