[Epidural anesthesia in thoracic and abdominal surgery : Current perspectives and practical implications].

Abstract

With the rise of minimally invasive and robot-assisted surgical techniques, the role of epidural anesthesia (EA) in modern practice necessitates careful re-evaluation. This review explores the relevance of EA in thoracic and abdominal surgery, examining its practical applications, residual indications and considerations for its use. Additionally, alternative pain management strategies, including systemic analgesia, regional nerve blocks and novel perioperative approaches, are assessed for advantages and limitations compared to EA.Traditionally the gold standard for perioperative pain control in thoracic and abdominal procedures, EA provides superior analgesia, reduced pulmonary complications and promotes early postoperative mobilization; however, the shift towards less invasive types of surgery has raised questions about the necessity and risk-benefit profile of EA. Complications such as hypotension, hematoma and rare neurological injuries emphasize the importance of thorough risk assessment.Emerging data show that alternative methods, such as transversus abdominis plane (TAP) blocks, paravertebral blocks and multimodal analgesia provide comparable efficacy in specific patient groups while often demonstrating a better safety profile. Nevertheless, EA remains essential in extensive thoracic surgery, complex abdominal resections and in patients with a high risk for severe postoperative pain or respiratory compromise. Combining EA with enhanced recovery after surgery (ERAS) protocols has also shown promise in improving outcomes.In conclusion, while minimally invasive surgical techniques have transformed perioperative care, EA retains a critical role in selected indications. Individualized planning of anesthesia, weighing EA against evolving alternatives and tailored to surgical and patient-specific factors, is essential. This review highlights the integration of evidence-based strategies to optimize the role of EA in contemporary surgical treatment.