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Meta-Analysis
. 2016 Jul 16;7(7):CD001893.
doi: 10.1002/14651858.CD001893.pub2.

Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

Joanne Guay  1 , Mina Nishimori, Sandra Kopp
Affiliations
Meta-Analysis

Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery

Joanne Guay et al. Cochrane Database Syst Rev. .

Abstract

Background: Gastrointestinal paralysis, nausea and vomiting and pain are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization and hospital costs. This review was first published in 2001 and was updated by new review authors in 2016.

Objectives: To compare effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of anastomotic leak, length of hospital stay and costs after abdominal surgery.

Search methods: We identified trials by conducting computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), MEDLINE (from 1950 to December 2014) and EMBASE (from 1974 to December 2014) and by checking the reference lists of trials retained. When we reran the search in February 2016, we added 16 potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate these studies into formal review findings during the next review update.

Selection criteria: We included parallel randomized controlled trials comparing effects of postoperative epidural local anaesthetic versus regimens based on systemic or epidural opioids.

Data collection and analysis: We rated the quality of studies by using the Cochrane 'Risk of bias' tool. Two review authors independently extracted data and judged the quality of evidence according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) scale.

Main results: We included 128 trials with 8754 participants in the review, and 94 trials with 5846 participants in the analysis. Trials included in the review were funded as follows: charity (n = 19), departmental resources (n = 8), governmental sources (n = 15) and industry (in part or in total) (n = 15). The source of funding was not specified for the other studies.Results of 22 trials including 1138 participants show that an epidural containing a local anaesthetic will decrease the time required for return of gastrointestinal transit as measured by time to first flatus after an abdominal surgery (standardized mean difference (SMD) -1.28, 95% confidence interval (CI) -1.71 to -0.86; high quality of evidence; equivalent to 17.5 hours). The effect is proportionate to the concentration of local anaesthetic used. A total of 28 trials including 1559 participants reported a decrease in time to first faeces (stool) (SMD -0.67, 95% CI -0.86 to -0.47; low quality of evidence; equivalent to 22 hours). Thirty-five trials including 2731 participants found that pain on movement at 24 hours after surgery was also reduced (SMD -0.89, 95% CI -1.08 to -0.70; moderate quality of evidence; equivalent to 2.5 on scale from 0 to 10). From findings of 22 trials including 1154 participants we did not find a difference in the incidence of vomiting within 24 hours (risk ratio (RR) 0.84, 95% CI 0.57 to 1.23; low quality of evidence). From investigators in 17 trials including 848 participants we did not find a difference in the incidence of gastrointestinal anastomotic leak (RR 0.74, 95% CI 0.41 to 1.32; low quality of evidence). Researchers in 30 trials including 2598 participants noted that epidural analgesia reduced length of hospital stay for an open surgery (SMD -0.20, 95% CI -0.35 to -0.04; very low quality of evidence; equivalent to one day). Data on costs were very limited.

Authors' conclusions: An epidural containing a local anaesthetic, with or without the addition of an opioid, accelerates the return of gastrointestinal transit (high quality of evidence). An epidural containing a local anaesthetic with an opioid decreases pain after abdominal surgery (moderate quality of evidence). We did not find a difference in the incidence of vomiting or anastomotic leak (low quality of evidence). For open surgery, an epidural containing a local anaesthetic would reduce the length of hospital stay (very low quality of evidence).

PubMed Disclaimer

Conflict of interest statement

Joanne Guay: I have had no direct relationship with any pharmaceutical company or equipment manufacturer in the past five years. I have not acted as a witness expert in the past five years. I am not an author of any of the included or excluded studies. I do not hold stock other than mutual funds. I am the editor of a multi‐author textbook on anaesthesia (including notions on general and regional anaesthesia). I receive fees for a course on airway management at University of Quebec, in Abitibi‐Temiscamingue.

Mina Nishimori: no conflicts of interest.

Sandra Kopp: no conflicts of interest.

Figures

1
1
Flow diagram. Study selection from the 2014 search. We reran the search in February 2016, and added 16 potential new studies of interest to the list of ‘Studies awaiting classification'. These studies will be incorporated into the formal review findings during the next review update. We also found one ongoing trial.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Meta‐regression of effects of the concentration of local anaesthetic used (mg/mL) after surgery on the standardized mean difference for return of gastrointestinal transit as measured by the time required to obtain first flatus. P value = 0.0008.
5
5
Meta‐regression of the effects of mean age of participants included in the study on VAS scores at rest at 48 hours (P value = 0.0002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.
6
6
Meta‐regression of the effects of mean age of participants included in the study on VAS scores on movement at 48 hours (P value = 0.002). Older participants benefit more from an epidural containing a local anaesthetic for an abdominal surgery.
1.1
1.1. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 1 Time to first flatus subgrouped by type of surgery.
1.2
1.2. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 2 Time to first faeces subgrouped according to duration of local anaesthetic administration.
1.3
1.3. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 3 Pain scores at rest at 6 to 8 hours after surgery subgrouped by type of surgery.
1.4
1.4. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 4 Pain scores on movement at 6 to 8 hours after surgery subgrouped by type of opioid in the control group.
1.5
1.5. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 5 Pain scores at rest at 24 hours subgrouped by type of opioid in the epidural.
1.6
1.6. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 6 Pain scores at rest at 24 hours subgrouped by opioid in the control group.
1.7
1.7. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 7 Pain scores on movement at 24 hours subgrouped by type of surgery.
1.8
1.8. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 8 Pain scores on movement at 24 hours subgrouped by type of opioid in the epidural.
1.9
1.9. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 9 Pain scores on movement at 24 hours subgrouped by type of opioids in the control group.
1.10
1.10. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 10 Pain scores at rest at 48 hours subgrouped by type of solution used.
1.11
1.11. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 11 Pain scores on movement at 48 hours subgrouped by type of solution in the epidural.
1.12
1.12. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 12 Pain scores at rest at 72 hours subgrouped by type of solution used.
1.13
1.13. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 13 Pain scores on movement at 72 hours subgrouped by type of solution used.
1.14
1.14. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 14 Vomiting.
1.15
1.15. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 15 Gastrointestinal tract anastomotic leak.
1.16
1.16. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 16 Length of stay in hospital subgrouped by type of surgery.
1.17
1.17. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 17 Length of stay in hospital subgrouped by surgical site for open surgery only.
1.18
1.18. Analysis
Comparison 1 Epidural with a local anaesthetic with or without opioids compared with opioid‐based regimen, Outcome 18 Costs.
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References

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Kumar 2004 {published data only}
    1. Kumar R, Prasanna A. Post operative analgesia with continuous epidural infusion. Middle East Journal of Anesthesiology 2004;17(5):899‐912. [PUBMED: 15449747] - PubMed
Lattermann 2007 {published data only}
    1. Lattermann R, Wykes L, Eberhart L, Carli F, Meterissian S, Schricker T. A randomized controlled trial of the anticatabolic effect of epidural analgesia and hypocaloric glucose. Regional Anesthesia and Pain Medicine 2007;32(3):227‐32. [PUBMED: 17543818] - PubMed
Levy 2011 {published data only}
    1. Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient‐controlled analgesia for patients undergoing laparoscopic colorectal surgery. The British Journal of Surgery 2011;98(8):1068‐78. [PUBMED: 21590762] - PubMed
Licker 1994 {published data only}
    1. Licker M, Suter PM, Krauer F, Rifat NK. Metabolic response to lower abdominal surgery: analgesia by epidural blockade compared with intravenous opiate infusion. European Journal of Anaesthesiology 1994;11(3):193‐9. [PUBMED: 7519554] - PubMed
Limberi 2003 {published and unpublished data}
    1. Grigorakos L. Information on our trial [personal communication]. Email to: J Guay 4 March 2016.
    1. Limberi S, Markou N, Sakayianni K, Vourliotou A, Kremastinou F, Savari E, et al. Coronary artery disease and upper abdominal surgery: impact of anesthesia on perioperative myocardial ischemia. Hepato‐gastroenterology 2003;50(54):1814‐20. [PUBMED: 14696412] - PubMed
Liu 1995 {published data only}
    1. Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TSJ, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthsiology 1995;83:757‐65. - PubMed
Liuboshevskii 2012 {published data only}
    1. Liuboshevskii PA, Artamonova NI, Ovechkin AM. [Haemostasis disturbances as the component of the surgical stress‐response and possibilities of their correction]. Anesteziologiia i Reanimatologiia 2012;57(3):44‐8. [PUBMED: 22993923] - PubMed
Lombardo 2009 {published data only}
    1. Lombardo L, Ruggia O, Crocella L, Masoero G, Foti M, Mambrini S, et al. Epidural plus general anesthesia vs general anesthesia alone for elective aortic surgery: effects on gastric electrical activity and serum gastrin secretion. Minerva Anestesiologica 2009;75(3):109‐15. [PUBMED: 19221543] - PubMed
Luchetti 1996 {published data only}
    1. Luchetti M, Palomba R, Sica G, Massa G, Tufano R. Effectiveness and safety of combined epidural and general anesthesia for laparoscopic cholecystectomy. Regional Anesthesia 1996;21(5):465‐9. [PUBMED: 8896010] - PubMed
Lugli 2008 {published and unpublished data}
    1. Carli F. Information on our trial [personal communication]. Email to: J Guay 4 May 2015.
    1. Lugli AK, Donatelli F, Schricker T, Wykes L, Carli F. Epidural analgesia enhances the postoperative anabolic effect of amino acids in diabetes mellitus type 2 patients undergoing colon surgery. Anesthesiology 2008;108(6):1093‐9. [PUBMED: 18497611] - PubMed
Lugli 2010 {published and unpublished data}
    1. Carli F. Information on our trial [personal communication]. Email to: J Guay 4 May 2015.
    1. Lugli AK, Donatelli F, Schricker T, Kindler C, Wykes L, Carli F. Protein balance in nondiabetic versus diabetic patients undergoing colon surgery: effect of epidural analgesia and amino acids. Regional Anesthesia and Pain Medicine 2010;35(4):355‐60. [PUBMED: 20607877] - PubMed
Malenkovic 2003 {published data only}
    1. Malenkovic V, Zoric S, Randelovic T. [Advantage of combined spinal, epidural and general anesthesia in comparison to general anesthesia in abdominal surgery] [Prednosti primene kombinovane spinalne, epiduralne i opste anestezije u odnosu na opstu anesteziju u abdominalnog hirurgiji.]. Srpski Arhiv za Celokupno Lekarstvo 2003;131(5‐6):232‐7. [PUBMED: 14692130] - PubMed
Mallinder 2000 {published data only}
    1. Mallinder PA, Hall JE, Bergin FG, Royle P, Leaper DJ. A comparison of opiate‐ and epidural‐induced alterations in splanchnic blood flow using intra‐operative gastric tonometry. Anaesthesia 2000;55(7):659‐65. [PUBMED: 10919421] - PubMed
Mann 2000 {published data only}
    1. Mann C, Pouzeratte Y, Boccara G, Peccoux C, Vergne C, Brunat G, D, et al. Comparison of intravenous or epidural patient‐controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 2000;92:433‐41. [PUBMED: 10691230] - PubMed
Marandola 2008 {published data only}
    1. Marandola M, Cilli T, Alessandri F, Tellan G, Caronna R, Chirletti P, et al. Perioperative management in patients undergoing pancreatic surgery: the anesthesiologist's point of view. Transplantation Proceedings 2008;40(4):1195‐9. [PUBMED: 18555147] - PubMed
Martella 2012 {published data only}
    1. Martella N, Cazzato MT, Vitale Di Maio F, Olivieri C, Marusco I, Sollazzi L. Epidural analgesia and fast‐track protocols in colorectal surgery: what benefits for the patient?. European Journal of Anaesthesiology. 2012; Vol. 29:29‐30. [EMBASE: 71084087]
Miller 1976 {published data only}
    1. Miller L, Gertel M, Fox GS, MacLean LD. Comparison of effect of narcotic and epidural analgesia on postoperative respiratory function. American Journal of Surgery 1976;131(3):291‐4. [PUBMED: 1259099] - PubMed
Moiniche 1993 {published data only}
    1. Moiniche S, Hjortso NC, Blemmer T, Dahl JB, Kehlet H. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. Acta Anaesthesiologica Scandinavica 1993;37(1):65‐9. [PUBMED: 8424297] - PubMed
Mondor 2010 {published and unpublished data}
    1. Massicotte L. Information on our trial [personal communication]. Email to: J Guay 10 July 2014.
    1. Mondor ME, Massicotte L, Beaulieu D, Roy JD, Lapointe R, Dagenais M, et al. Long‐lasting analgesic effects of intraoperative thoracic epidural with bupivacaine for liver resection. Regional Anaesthesia and Pain Medicine 2010;35(1):51‐6. [PUBMED: 20048658] - PubMed
Motamed 1998 {published and unpublished data}
    1. Jay C. Information on our trial [personal communication]. Email to: J Guay 10 July 2014.
    1. Jayr C. Information on our trial [personal communication]. Email to: J Guay 5 august 2014.
    1. Motamed C, Spencer A, Farhat F, Bourgain JL, Lasser P, Jayr C. Postoperative hypoxaemia: continuous extradural infusion of bupivacaine and morphine vs patient‐controlled analgesia with intravenous morphine. British Journal of Anaesthesia 1998;80(6):742‐7. [PUBMED: 9771300] - PubMed
Muehling 2009 {published data only}
    1. Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder‐Plassmann L, Orend KH. A prospective randomized trial comparing traditional and fast‐track patient care in elective open infrarenal aneurysm repair. World Journal of Surgery 2009;33(3):577‐85. [PUBMED: 19137363] - PubMed
Neudecker 1999 {published data only}
    1. Neudecker J, Schwenk W, Junghans T, Pietsch S, Bohm B, Muller JM. Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. The British Journal of Surgery 1999;86(10):1292‐5. [PUBMED: 10540136] - PubMed
Norman 1997 {published data only}
    1. Norman JG, Fink GW. The effects of epidural anesthesia on the neuroendocrine response to major surgical stress: a randomized prospective trial. The American Surgeon 1997;63(1):75‐80. [PUBMED: 8985076] - PubMed
O'Connor 2006 {published data only}
    1. O'Connor PJ, Hanson J, Finucane BT. Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery. Canadian Journal of Anaesthesia 2006;53(9):873‐80. [PUBMED: 16960264] - PubMed
    1. Tsui BC, Rashiq S, Schopflocher D, Murtha A, Broemling S, Pillay J, et al. Epidural anaesthesia and cancer recurrence rates after radical prostatectomy. Canadian Journal of Anaesthesia 2010;57(2):107‐12. [PUBMED: 19911247] - PubMed
Ozcan 2004 {published data only}
    1. Ozcan S, Tabuk M, Baltaci B, Unal N. [Is epidural preemptive analgesia effective in lower abdominal surgery?] [Alt abdominal cerrahi girisimlerde epidural preemptif analjezi etkili midir?]. Agri: Agri (Algoloji) Dernegi'nin Yayin Organidir 2004;16(1):58‐63. [PUBMED: 15152589] - PubMed
Ozdilmac 2003 {published data only}
    1. Ozdilmac I, Altintas F, Salihoglu Z, Demiroluk S, Aydin S, Uzun H. The effect of general anesthesia and epidural combined with general anesthesia on the response of surgical stress during abdominal surgery. [[Alt batin cerrahisinde genel anestezi ile epidural+genel anestezi uygulamasinin stres yanita etkileri]]. Anesteziyoloji ve Reanimasyon Uzmanları Derneği 2003;11(3):195‐200. [EMBASE: 2003409523]
Ozturk 2010 {published data only}
    1. Ozturk N, Uluer PD, Saydam GS, Topcu DI, Gulapoglu H, Cebi YA, et al. The effect of peroperative epidural analgesia with levobupivacaine on the response of oxidative stress during nefrectomy operations. [[Nefrektomi olgularinda levobupivakain ile saglanan peroperatif epidural analjezinin oksidatif stres uzerine etkisi]]. Anesteziyoloji ve Reanimasyon Uzmanları Derneği 2010;18(1):43‐9. [EMBASE: 2010277555]
Park 2001 {published data only}
    1. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Annals of Surgery 2001;234(4):560‐9; discussion 569‐71. [PUBMED: 11573049] - PMC - PubMed
Paulsen 2001 {published data only}
    1. Paulsen EK, Porter MG, Helmer SD, Linhardt PW, Kliewer ML. Thoracic epidural versus patient‐controlled analgesia in elective bowel resections. American Journal of Surgery 2001;182(6):570‐7. [PUBMED: 11839319] - PubMed
Peyton 2003 {published data only}
    1. Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI, ANZCA Trials Group Investigators. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence‐free survival: randomised trial. BMJ 2011;342(March 29):d1491. [PUBMED: 21447587 ] - PubMed
    1. Peyton PJ, Myles PS, Silbert BS, Rigg JA, Jamrozik K, Parsons R. Perioperative epidural analgesia and outcome after major abdominal surgery in high‐risk patients. Anesthesia and Analgesia 2003;96(2):548‐54. [PUBMED: 12538211] - PubMed
    1. Rigg JR, Jamrozik K, Myles PS, Silbert B, Peyton P, Parsons RW, et al. Design of the multicenter Australian study of epidural anaesthesia and analgesia in major surgery: the MASTER trial. Controlled Clinical Trials 2000;2(3):244‐56. [PUBMED: 10822122 ] - PubMed
    1. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002;13(359):1276‐82. [PUBMED: 11965272 ] - PubMed
Pflug 1974 {published data only}
    1. Pflug AE, Murphy TM, Butler SH, Tucker GT. The effects of postoperative peridural analgesia on pulmonary therapy and pulmonary complications. Anesthesiology 1974;41(1):8‐17. [PUBMED: 4599641] - PubMed
Rimaitis 2003 {published data only}
    1. Rimaitis K, Marchertiene I, Pavalkis D. [Comparison of two different methods of analgesia. Postoperative course after colorectal cancer surgery] [Skirtingu skausmo malsinimo metodu veiksmingumo ivertinimas bei ju itaka pooperacinei eigai po storosios zarnos vezio rezekciniu operaciju]. Medicina (Kaunas, Lithuania) 2003;39(2):129‐37. [PUBMED: 12626865] - PubMed
Riwar 1991 {published data only}
    1. Riwar A, Schär B, Grötzinger U. Effect of continuous postoperative analgesia with bupivacaine on intestinal motility following colorectal resection [Effekt der kontinuierlichen postoperativen analgesie mit bupivacain peridural auf die darmmotilität nach kolorektalen resektionen]. Helvetica Chirurgica Acta 1991;58:729‐33. - PubMed
Rockemann 1996 {published data only}
    1. Rockemann MG, Seeling W, Bischof C, Borstinghaus D, Steffen P, Georgieff M. Prophylactic use of epidural mepivacaine/morphine, systemic diclofenac, and metamizole reduces postoperative morphine consumption after major abdominal surgery. Anesthesiology 1996;84(5):1027‐34. [PUBMED: 8623995] - PubMed
Rockemann 1997 {published and unpublished data}
    1. Rockemann MG. Information on our trial [personal communication]. Email to: J Guay 6 July 2015.
    1. Rockemann MG. Information on our trial [personal communication]. Email to: J Guay 8 July 2015.
    1. Rockemann MG, Seeling W, Goertz AW, Konietzko I, Steffen P, Georgieff M. [Effectiveness, side effects and costs of postoperative pain therapy: intravenous and epidural patient‐controlled analgesia (PCA)] [Wirksamkeit, Nebenwirkungen und Kosten postoperativer Schmerztherapie: Intravenose und epidurale patientenkontrollierte Analgesie (PCA)]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 1997;32(7):414‐9. [PUBMED: 9340029] - PubMed
Rutberg 1984 {published data only}
    1. Håkanson E, Rutberg H, Jorfeldt L, Mårtensson J. Effects of the extradural administration of morphine, or bupivacaine, on the metabolic response to upper abdominal surgery. British Journal of Anaesthesia 1985;57(4):394‐9. [PUBMED: 3986067] - PubMed
    1. Rutberg H, Håkanson E, Anderberg B, Jorfelt L, Mårtensson J, Schildt B. Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. British Journal of Anaesthesia 1984;56:233‐8. - PubMed
Salomaki 1995 {published data only}
    1. Salomaki TE, Laitinen JO, Vainionpaa V, Nuutinen LS. 0.1% bupivacaine does not reduce the requirement for epidural fentanyl infusion after major abdominal surgery. Regional Anesthesia 1995;20(5):435‐43. [PUBMED: 8519722] - PubMed
Scheinin 1982 {published data only}
    1. Scheinin B, Rosenberg PH. Effect of prophylactic epidural morphine or bupivacaine on postoperative pain after upper abdominal surgery. Acta Anaesthesiologica Scandinavica 1982;26(5):474‐8. [PUBMED: 6815974] - PubMed
Scheinin 1987 {published data only}
    1. Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiologica Scandinavica 1987;31:161‐4. - PubMed
Schricker 2000 {published data only}
    1. Schricker T, Wykes L, Carli F. Epidural blockade improves substrate utilization after surgery. American Journal of Physiology. Endocrinology and Metabolism 2000; Vol. 279, issue 3:E646‐53. [PUBMED: 10950834] - PubMed
Schricker 2002 {published data only}
    1. Schricker T, Wykes L, Eberhart L, Lattermann R, Mazza L, Carli F. The anabolic effect of epidural blockade requires energy and substrate supply. Anesthesiology 2002;97(4):943‐51. [PUBMED: 12357163] - PubMed
Schricker 2004 {published data only}
    1. Schricker T, Meterissian S, Wykes L, Eberhart L, Lattermann R, Carli F. Postoperative protein sparing with epidural analgesia and hypocaloric dextrose. Annals of Surgery 2004;240(5):916‐21. [PUBMED: 15492576] - PMC - PubMed
Schulze 1988 {published data only}
    1. Kehlet H. Information on our trial [personal communication]. Email to: J Guay 3 June 2016.
    1. Schulze S, Roikjaer O, Hasselstrom L, Jensen NH, Kehlet H. Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. Surgery 1988;103(3):321‐7. [PUBMED: 3344486] - PubMed
Schulze 1992 {published data only}
    1. Kehlet H. Information on our trial [personal communication]. Email to: J Guay 31 May 2016.
    1. Schulze S, Sommer P, Bigler D, Honnens M, Shenkin A, Cruickshank AM, et al. Effect of combined prednisolone, epidural analgesia, and indomethacin on the systemic response after colonic surgery. Archives of Surgery 1992;127(3):325‐31. [PUBMED: 1550481] - PubMed
Schumann 2003 {published and unpublished data}
    1. Schumann R. Information on our trial [personal communication]. Email to: J Guay 6 August 2014.
    1. Schumann R, Shikora S, Weiss JM, Wurm H, Strassels S, Carr DB. A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesthesia and Analgesia 2003;96(2):469‐74. [PUBMED: 12538198] - PubMed
Seeling 1990 {published data only}
    1. Seeling W, Bruckmooser KP, Hufner C, Kneitinger E, Rigg C, Rockemann M. [No reduction in postoperative complications by the use of catheterized epidural analgesia following major abdominal surgery] [Keine Verminderung postoperativer Komplikationen durch Katheterepiduralanalgesie nach grossen abdominellen Eingriffen]. Der Anaesthesist 1990;39(1):33‐40. [PUBMED: 2407144] - PubMed
Seeling 1990a {published data only}
    1. Seeling W, Kustermann J, Schneider E. [Postoperative peridural analgesia via catheter following abdominal surgery. Peridural bupivacaine versus buprenorphine] [Postoperative Katheterperiduralanalgesie nach abdominellen Eingriffen. Bupivacain versus Buprenorphin peridural.]. Regional‐Anaesthesie 1990;13(3):78‐87. [PUBMED: 2192406] - PubMed
Seeling 1991 {published data only}
    1. Seeling W, Bothner U, Eifert B, Rockemann M, Schreiber M, Schurmann W, et al. [Patient‐controlled analgesia versus epidural analgesia using bupivacaine or morphine following major abdominal surgery. No difference in postoperative morbidity] [Patientenkontrollierte Analgesie versus Epiduralanalgesie mit Bupivacain oder Morphin nach grossen abdominellen Eingriffen. Kein Unterschied in der postoperativen Morbiditat.]. Der Anaesthesist 1991;40(11):614‐23. [PUBMED: 1755532] - PubMed
Senagore 2003 {published data only}
    1. Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW. Randomized clinical trial comparing epidural anaesthesia and patient‐controlled analgesia after laparoscopic segmental colectomy. The British Journal of Surgery 2003;90(10):1195‐9. [PUBMED: 14515286] - PubMed
Siniscalchi 2003 {published data only}
    1. Siniscalchi A, Begliomini B, Matteo G, Pietri L, Pasetto A. Intraoperative effects of combined versus general anesthesia during major liver surgery. Minerva Anestesiologica 2003;69(12):885‐95. [PUBMED: 14743120] - PubMed
Steinberg 2002 {published and unpublished data}
    1. Gibson C. Information on our trial [personal communication]. Email to: J Guay 7 August 2014.
    1. Steinberg RB, Liu SS, Wu CL, Mackey DC, Grass JA, Ahlen K, et al. Comparison of ropivacaine‐fentanyl patient‐controlled epidural analgesia with morphine intravenous patient‐controlled analgesia for perioperative analgesia and recovery after open colon surgery. Journal of Clinical Anesthesia 2002;14(8):571‐7. [PUBMED: 12565114] - PubMed
Stevens 1998 {published data only}
    1. Stevens RA, Mikat‐Stevens M, Flanigan R, Waters WB, Furry P, Sheikh T, et al. Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?. Urology 1998;52(2):213‐8. [PUBMED: 9697784] - PubMed
St‐Onge 1997 {published data only}
    1. St‐Onge S, Fugere F, Girard M. Bupivacaine decreases epidural meperidine requirements after abdominal surgery. Canadian Journal of Anaesthesia 1997;44(4):360‐6. [PUBMED: 9104516] - PubMed
Subramaniam 2000 {published data only}
    1. Subramaniam B, Pawar DK, Kashyap L. Pre‐emptive analgesia with epidural morphine or morphine and bupivacaine. Anaesthesia and Intensive Care 2000;28(4):392‐8. [PUBMED: 10969365] - PubMed
Taqi 2007 {published data only}
    1. Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surgical Endoscopy 2007;21(2):247‐52. [PUBMED: 17160649] - PubMed
Thorén 1989 {published data only}
    1. Thorén T, Sundberg A, Wattwil M, Garvill JE, Jürgensen U. Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy. Acta Anaesthesiologica Scandinavica 1989;33:181‐5. - PubMed
Tsui 1997 {published and unpublished data}
    1. Tsui SL. Information on our trial [personal communication]. Email to: J Guay 4 September 2014.
    1. Tsui SL, Lee DK, Ng KF, Chan TY, Chan WS, Lo JW. Epidural infusion of bupivacaine 0.0625% plus fentanyl 3.3 micrograms/ml provides better postoperative analgesia than patient‐controlled analgesia with intravenous morphine after gynaecological laparotomy. Anaesthesia and Intensive Care 1997;25(5):476‐81. [PUBMED: 9352758] - PubMed
Tuman 1991 {published data only}
    1. Tuman KJ, McCarthy RJ, March RJ, DeLaria GA, Patel RV, Ivankovich AD. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesthesia and Analgesia 1991;73(6):696‐704. [PUBMED: 1952169] - PubMed
Turunen 2009 {published data only}
    1. Turunen P, Carpelan‐Holmstrom M, Kairaluoma P, Wikstrom H, Kruuna O, Pere P, et al. Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study. Surgical Endoscopy 2009;23(1):31‐7. [PUBMED: 18814016] - PubMed
Tyagi 2011 {published data only}
    1. Tyagi A, Seelan S, Sethi AK, Mohta M. Role of thoracic epidural block in improving post‐operative outcome for septic patients: a preliminary report. European Journal of Anaesthesiology 2011;28(4):291‐7. [PUBMED: 21119517] - PubMed
Voylenko 2013 {published data only}
    1. Voylenko O, Vitruk IV, Stakhovskyi O, Kotov VA, Stakhovsky E. Fast track surgery in partial resection for renal cell Carcinoma. EAU 13th Central European Meeting, CEM and the EAU 9th South Eastern European Meeting. 2013; Vol. 12:e1374.
Wallin 1986 {published data only}
    1. Wallin G, Cassuto J, Högström S, Rimbäck G, Faxén A, Tolleson PO. Failure of epidural anaesthesia to prevent postoperative paralytic ileus. Anesthesiology 1986;65:292‐7. - PubMed
Wang 2010 {published data only}
    1. Wang TB, Shi HP, Lin WH, Ye ZJ, Zhang CG. Clinical practice of fast track surgery in colon carcinoma operation [Original title available in Chinese characters only]. Journal of Cancer Prevention and Treatment 2010;17(22):1868‐70. [EMBASE: 2011264312]
Watters 1993 {published data only}
    1. Watters JM, March RJ, Desai D, Monteith K, Hurtig JB. Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery. Canadian Journal of Anaesthesia 1993;40(4):314‐9. [PUBMED: 8485790] - PubMed
Wattwil 1989 {published data only}
    1. Wattwil M, Thorén T, Hennerdal S, Garvill JE. Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy. Anesthesia and Analgesia 1989;68:353‐8. - PubMed
Welch 1998 {published data only}
    1. Welch JP, Cohen JL, Vignati PV, Allen LW, Morrow JS, Carter JJ. Pain control following elective gastrointestinal surgery: is epidural anaesthesia warranted?. Connecticut Medicine 1998;62(8):461‐4. [PUBMED: 9753804] - PubMed
Wiedemann 1991 {published data only}
    1. Wiedemann B, Leibe S, Katzel R, Grube U, Landgraf R, Bierwolf B. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics] [Der Einfluss epiduraler Kombinationsanaesthesieverfahren bei Oberbaucheingriffen auf Stressreaktion, Schmerzverhalten und Atemmechanik]. Der Anaesthesist 1991;40(11):608‐13. [PUBMED: 1755531] - PubMed
Yeager 1987 {published data only}
    1. Yeager MP, Glass DD, Neff RK, Brinck‐Johnsen T. Epidural anesthesia and analgesia in high‐risk surgical patients. Anesthesiology 1987;66:729‐36. [PUBMED: 3296854] - PubMed
Zeng 2003 {published data only}
    1. Zeng L, Wu X, Ma Q, Su Y. Effect of different methods for postoperative pain management on catecholamine response to abdominal surgery [Original title available in Chinese characters only]. Beijing da Xue Xue Bao. Yi Xue Ban 2003;35(2):187‐90. [MEDLINE: ] - PubMed
Zhu 2013 {published data only}
    1. Zhu Z, Wang C, Xu C, Cai Q. Influence of patient‐controlled epidural analgesia versus patient‐controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer 2013;16(2):193‐200. [PUBMED: 22806415] - PubMed
Zutshi 2005 {published data only}
    1. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anaesthesia/analgesia after laparotomy and intestinal resection. American Journal of Surgery 2005;189(3):268‐72. [PUBMED: 15792748] - PubMed

References to studies excluded from this review

Akarsu 2012 {published data only}
    1. Akarsu Ayazotlu T, Eseotlu I, Candan A, Ozensoy A, Otut A. Combined epidural anesthesia + TIVA vs TIVA for major abdominal surgery. Regional Anesthesia and Pain Medicine 2012;37(5 Suppl 1):E221. [EMBASE: 70880924]
Ali 2010 {published data only}
    1. Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P. Prospective, randomized, controlled trial of thoracic epidural or patient‐controlled opiate analgesia on perioperative quality of life. British Journal of Anaesthesia 2010;104(3):292‐7. [PUBMED: 20124282] - PubMed
Aono 1998 {published data only}
    1. Aono H, Takeda A, Tarver SD, Goto H. Stress responses in three different anaesthetic techniques for carbon dioxide laparoscopic cholecystectomy. Journal of Clinical Anaesthesia 1998;10(7):546‐50. [PUBMED: 9805694] - PubMed
Aribogan 2003 {published data only}
    1. Aribogan A, Doruk N, Aridogan A, Akin S, Balcioglu O. Patient‐controlled epidural analgesia after major urologic surgeries. A comparison of tramadol with or without bupivacaine. Urologia Internationalis 2003;71(2):168‐75. [PUBMED: 12890955] - PubMed
Asantila 1991 {published data only}
    1. Asantila R, Eklund P, Rosenberg PH. Continuous epidural infusion of bupivacaine and morphine for postoperative analgesia after hysterectomy. Acta Anaesthesiologic Scandinavia 1991;35:513‐7. - PubMed
Axelsson 2005 {published data only}
    1. Axelsson K, Johanzon E, Essving P, Weckstrom J, Ekback G. Postoperative extradural analgesia with morphine and ropivacaine. A double‐blind comparison between placebo and ropivacaine 10 mg/h or 16 mg/h. Acta Anaesthesiologica Scandinavica 2005;49(8):1191‐9. [PUBMED: 16095462] - PubMed
Badner 1994 {published data only}
    1. Badner NH, Bhandari R, Komar WE. Bupivacaine 0.125% improves continuous postoperative epidural fentanyl analgesia after abdominal or thoracic surgery. Canadian Journal of Anaesthesia 1994;41(5 Pt 1):387‐92. [PUBMED: 8055605] - PubMed
Baron 1991 {published data only}
    1. Baron JF, Bertrand M, Barre E, Godet G, Mundler O, Coriat P, et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology 1991;75(4):611‐8. [PUBMED: 1928770] - PubMed
Basse 2002 {published data only}
    1. Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel HW, et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. The British Journal of Surgery 2002;89(4):446‐53. [PUBMED: 11952586] - PubMed
Beeby 1984 {published data only}
    1. Beeby D, MacIntosh KC, Bailey M, Welch DB. Postoperative analgesia for caesarean section using epidural methadone. Anaesthesia 1984;39:61‐3. - PubMed
Bigler 1989 {published data only}
    1. Bigler D, Dirkes W, Hansen R, Rosenberg J, Kehlet H. Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy. Acta Anaesthesiologica Scandinavica 1989;33(7):561‐4. [PUBMED: 2683543] - PubMed
Bloch 1989 {published data only}
    1. Bloch P, Modiano P. [A prospective randomized study comparing peridural anaesthesia and general anesthesia in sus‐mesocolic digestive surgery] [Etude prospective randomisee comparant anesthésie peridurale (APD) et anesthésie générale (AG) en chirurgie digestive sus‐mesocolique]. Annales de Chirurgie. 1989; Vol. 43, issue 9:768. [CENTRAL: CN‐00335077 ]
Bowdle 1997 {published data only}
    1. Bowdle TA, Ready LB, Kharasch ED, Nichols WW, Cox K. Transition to post‐operative epidural or patient‐controlled intravenous analgesia following total intravenous anaesthesia with remifentanil and propofol for abdominal surgery. European Journal of Anaesthesiology 1997;14(4):374‐9. [PUBMED: 9253564] - PubMed
Brandt 1976 {published data only}
    1. Brandt MR, Kehlet H, Skovsted L, Hansen JM. Rapid decrease in plasma‐triiodothyronine during surgery and epidural analgesia independent of afferent neurogenic stimuli and of cortisol. Lancet 1976;2(7999):1333‐6. [PUBMED: 63806] - PubMed
Brandt 1978 {published data only}
    1. Brandt MR, Fernades A, Mordhorst R, Kehlet H. Epidural analgesia improves postoperative nitrogen balance. British Medical Journal 1978;1(6120):1106‐8. [PUBMED: 638618] - PMC - PubMed
Bredtmann 1990 {published data only}
    1. Bredtmann RD, Herden HN, Teichmann W, Moecke HP, Kniesel B, Baetgen R, et al. Epidural analgesia in colonic surgery: results of a randomized prospective study. British Journal of Surgery 1990;77:638‐42. - PubMed
Bredtmann 1991 {published data only}
    1. Bredtmann RD, Kniesel B, Herden HN, Teichmann W. [The effect of continuous thoracic peridural anesthesia on the pulmonary function of patients undergoing colon surgery. Results of a randomized study of 116 patients] [Einfluss der kontinuierlichen thorakalen Periduralanaesthesie auf die Lungenfunktion kolonchirurgischer Patienten. Ergebnisse einer randomisierten Untersuchung an 116 Patienten]. Regional‐Anaesthesie 1991;14(1):2‐8. [PUBMED: 2006346] - PubMed
Bridenbaugh 1976 {published data only}
    1. Bridenbaugh PO, Balfour RI, Bridenbaugh LD, Lysons DF. Bupivacaine and etidocaine for lumbar epidural anesthesia for intra‐abdominal pelvic surgery, a double‐blind study. Anesthesiology 1976;45(5):560‐4. [PUBMED: 788557] - PubMed
Brodner 2000 {published data only}
    1. Brodner G, Mertes N, Aken HV, Möllhoff T, Zahl M, Wirtz S, et al. What concentration of sufentanil should be combined with ropivacaine 0.2% wt/vol for postoperative patient‐controlled epidural analgesia?. Anesthesia and Analgesia 2000;90:649‐57. - PubMed
Bromage 1955 {published data only}
    1. Bromage PR. Spirometry in assessment of analgesia after abdominal surgery; a method of comparing analgesic drugs. British Medical Journal 1955;2(4939):589‐93. [PUBMED: 13240186] - PMC - PubMed
Bromage 1971 {published data only}
    1. Bromage PR, Shibata HR, Willoughby HW. Influence of prolonged epidural blockade on blood sugar and cortisol responses to operations upon the upper part of the abdomen and the thorax. Surgery, Gynecology and Obstetrics 1971;132(6):1051‐6. [PUBMED: 5578429] - PubMed
Brownridge 1985 {published data only}
    1. Brownridge P, Frewin DB. A comparative study of techniques of postoperative analgesia following caesarean section and lower abdominal surgery. Anaesthesia and Intensive Care Journal 1985;13:123‐30. - PubMed
Buckley 1978 {published data only}
    1. Buckley FP, Littlewood DG, Covino BG, Scott DB. Effects of adrenaline and the concentration of solution on extradural block with etidocaine. British Journal of Anaesthesia 1978;50:171‐5. - PubMed
Buckley 1982 {published data only}
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Carli 1991 {published data only}
    1. Carli F, Webster J, Pearson J, Bartlett S, Bannister P, Halliday D. Protein metabolism after abdominal surgery: effect of 24‐h extradural block with local anaesthetic. British Journal of Anaesthesia 1991;67:729‐34. - PubMed
Carli 1995 {published data only}
    1. Carli F, Kulkarni P, Webster JD, MacDonald IA. Post‐surgery epidural blockade with local anaesthetics attenuates the catecholamine and thermogenic response to perioperative hypothermia. Acta Anaesthesiologica Scandinavica 1995;39(8):1041‐7. [PUBMED: 8607306] - PubMed
Casati 2002 {published data only}
    1. Casati L, Fernandez‐Galinski S, Barrera E, Pol O, Puig MM. Isoflurane requirements during combined general/epidural anesthesia for major abdominal surgery. Anesthesia and Analgesia 2002;94(5):1331‐7. [PUBMED: 11973215] - PubMed
Catley 1985 {published data only}
    1. Catley DM, Thornton C, Jordan C, Lehane JR, Royston D, Jones JG. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 1985;63(1):20‐8. [PUBMED: 4014768] - PubMed
Chestnut 1986 {published data only}
    1. Chestnut DH, Choi WW, Isbell TJ. Epidural hydromorphone for postcesarean analgesia. Obstetrics and Gynecology 1986;68(1):65‐9. [PUBMED: 2425315] - PubMed
Cooper 1996 {published data only}
    1. Cooper DW, Ryall DM, McHardy FE, Lindsay SL, Eldabe SS. Patient‐controlled extradural analgesia with bupivacaine, fentanyl, or a mixture of both, after caesarean section. British Journal of Anaesthesia 1996;76:611‐5. - PubMed
Cowen 1982 {published data only}
    1. Cowen MJ, Bullingham RE, Paterson GM, McQuay HJ, Turner M, Allen MC, et al. A controlled comparison of the effects of extradural diamorphine and bupivacaine on plasma glucose and plasma cortisol in postoperative patients. Anesthesia and Analgesia 1982;61(1):15‐8. [PUBMED: 7198407] - PubMed
Crews 1999 {published data only}
    1. Crews JC, Hord AH, Denson DD, Schatzman C. A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesthesia and Analgesia 1999;89(6):1504‐9. [PUBMED: 10589637] - PubMed
Dahl 1992 {unpublished data only}
    1. Dahl JB, Rosenberg J, Hansen BL, Hjortso NC, Kehlet H. Differential analgesic effects of low‐dose epidural morphine and morphine‐bupivacaine at rest and during mobilization after major abdominal surgery. Anesthesia and Analgesia 1992;74(3):362‐5. [PUBMED: 1539815] - PubMed
De Kock 1999 {published data only}
    1. Kock M, Gautier P, Pavlopoulou A, Jonniaux M, Lavand'homme P. Epidural clonidine or bupivacaine as the sole analgesic agent during and after abdominal surgery: a comparative study. Anesthesiology 1999;90(5):1354‐62. [PUBMED: 10319784] - PubMed
Delilkan 1993 {published data only}
    1. Delilkan AE, Vijayan R. Epidural tramadol for postoperative pain relief. Anaesthesia 1993;48:328‐31. - PubMed
Dupont 1987 {published data only}
    1. Dupont D, Velin P, Cabour F, Candito M, Rives E. Effect of caudal anaesthesia on catacholamine secretion in children [Influence de l'anesthésie caudale sur la sécrétion des catécholamines chez l'enfant]. Annales Françaises d'Anesthésie et de Réanimation 1987;6:156‐8. - PubMed
Dyer 1992 {published data only}
    1. Dyer RA, Camden‐Smith K, James MFM. Epidural lidocaine with sufentanil and epinephrine for abdominal hysterectomy under general anaesthesia: respiratory deprssion and postoperative analgesia. Canadian Journal of Anaesthesia 1992;39:220‐5. - PubMed
Engquist 1977 {published data only}
    1. Engquist A, Brandt MR, Fernandes A, Kehlet H. The blocking effect of epidural analgesia on the adrenocortical and hyperglycemic responses to surgery. Acta Anaesthesiologica Scandinavica 1977;21(4):330‐5. [PUBMED: 906788] - PubMed
Engquist 1980 {published data only}
    1. Engquist A, Fog‐Moller F, Christiansen C, Thode J, Vester‐Andersen T, Madsen SN. Influence of epidural analgesia on the catecholamine and cyclic AMP responses to surgery. Acta Anaesthesiologica Scandinavica 1980;24(1):17‐21. [PUBMED: 6246705] - PubMed
Etches 1997 {published data only}
    1. Etches RC, Writer WD, Ansley D, Nydahl PA, Ong BY, Lui A, et al. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery. Anesthesia and Analgesia 1997;84(4):784‐90. [PUBMED: 9085958] - PubMed
Feo 2009 {published data only}
    1. Feo CV, Lanzara S, Sortini D, Ragazzi R, Pinto M, Pansini GC, et al. Fast track postoperative management after elective colorectal surgery: a controlled trial. The American Surgeon 2009;75(12):1247‐51. [PUBMED: 19999921] - PubMed
Frings 1982 {published data only}
    1. Frings N, Bormann Bv, Kroh U, Lennartz H. Peridural anesthesia and analgesia results in general surgery [Peridurale anaesthesie‐ und analgesieverfahren in der allgemeinchirurgie]. Chirurg 1982;53:184‐8. - PubMed
Fujita 2011 {published data only}
    1. Fujita Y, Nakamura K, Horiguchi Y, Ikeda D, Kaneko M, Tomioka K, et al. [Effect of different perioperative analgesic methods on postoperative cognitive dysfunction in elderly patients undergoing upper abdominal surgery]. Masui. The Japanese Journal of Anesthesiology 2011;60(10):1153‐8. [PUBMED: 22111354] - PubMed
Garnett 1996 {published data only}
    1. Garnett RL, MacIntyre A, Lindsay P, Barber GG, Cole CW, Hajjar G, et al. Perioperative ischaemia in aortic surgery: combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia. Canadian Journal of Anaesthesia 1996;43(8):769‐77. [PUBMED: 8840054] - PubMed
Geddes 1991 {published data only}
    1. Geddes SM, Thorburn J, Logan RW. Gastric emptying following caesarean section and the effect of epidural fentanyl. Anaesthesia 1991;46:1016‐8. - PubMed
Gelman 1977 {published data only}
    1. Gelman S, Feigenberg Z, Dintzman M, Levy E. Electroenterography after cholecystectomy. Archives of Surgery 1977;112:580‐3. - PubMed
Gelman 1980 {published data only}
    1. Gelman S, Laws HL, Potzick J, Strong S, Smith L, Erdemir H. Thoracic epidural vs balanced anesthesia in morbid obesity: an intraoperative and postoperative hemodynamic study. Anesthesia and Analgesia 1980;59(12):902‐8. [PUBMED: 7192509] - PubMed
George 1992 {published data only}
    1. George KA, Chisakuta AM, Gamble JAS, Browne GA. Thoracic epidural infusion for postoperative pain relief following abdominal aorta surgery: bupivacaine, fentanyl or a mixture of both?. Anaesthesia 1992;47:388‐94. - PubMed
Gold 1994 {published data only}
    1. Gold MS, DeCrosta D, Rizzuto C, Ben‐Harari RR, Ramanathan S. The effect of lumbar epidural and general anesthesia on plasma catecholamines and hemodynamics during abdominal aortic aneurysm repair. Anesthesia and Analgesia 1994;78(2):225‐30. [PUBMED: 8311273] - PubMed
Gow 1979 {published data only}
    1. Gow NM, Cochrane JP. The effect of epidural analgesia on postoperative sodium balance. The British Journal of Surgery 1979;66(12):864‐7. [PUBMED: 509060] - PubMed
Grass 1992 {published data only}
    1. Grass JA, Sakima NT. Epidural anaesthesia and analgesia results ln shorter hospital stay after total abdominal hysterectomy. Regional Anesthesia and Pain Medicine 1992;17(Suppl 1):77.
Grass 1993 {published data only}
    1. Grass JA, Sakima NT, Valley M, Fischer K, Jackson C, Walsh P, et al. Assessment of ketorolac as an adjuvant to fentanyl patient‐controlled epidural analgesia after radical retropubic prostatectomy. Anesthesiology 1993;78:642‐8. - PubMed
Gulucu 2009 {published data only}
    1. Gulucu C, Yilmaz AA, Yalcin S, Can OS, Demiralp S, Alkis N. [The effects of patient controlled analgesia methods with intravenous and epidural morphine on cognitive functions in geriatric patients] [Geriatrik hastalarda intravezoz ve epidural morfin ile hasta kontrollu analjeziuygulamasinin kognitif fonksiyonlar uzerine etkisi]. Anesteziyoloji ve Reanimasyon Uzmanları Derneği 2009;17(1):41‐8. [CENTRAL: CN‐00754806 ]
Gupta 2006 {published data only}
    1. Gupta A, Fant F, Axelsson K, Sandblom D, Rykowski J, Johansson JE, et al. Postoperative analgesia after radical retropubic prostatectomy: a double‐blind comparison between low thoracic epidural and patient‐controlled intravenous analgesia. Anesthesiology 2006;105(4):784‐93. [PUBMED: 17006078] - PubMed
Han 2005 {published data only}
    1. Han C, Zhou X, Qian Y, Yu L, Hao X. Effects of different analgesic techniques on blood glucose, insulin and cortisol in post‐hysterectomy patients [Original title available only in Chinese characters]. Journal of Xi'an Jiaotong University (Medical Sciences) 2005;26(2):191‐4. [EMBASE: 2005214273]
Harukuni 1995 {published data only}
    1. Harukuni I, Yamaguchi H, Sato S, Naito H. The comparison of epidural fentanyl, epidural lidocaine, and intravenous fentanyl in patients undergoing gastrectomy. Anesthesia and Analgesia 1995;81:1169‐74. - PubMed
Hashimoto 1995 {published data only}
    1. Hashimoto T, Hashimoto S, Hori Y, Nakagawa H, Hosokawa T. Epidural anaesthesia blocks changes in peripheral lymphocytes subpopulation during gastrectomy for stomach cancer. Acta Anaesthesiologica Scandinavica 1995;39(3):294‐8. [PUBMED: 7793203] - PubMed
Hendolin 1982 {published data only}
    1. Hendolin H, Tuppurainen T, Lahtinen J. Thoracic epidural analgesia and deep vein thrombosis in cholecystectomized patients. Acta Chirurgica Scandinavica 1982;148(5):405‐9. [PUBMED: 6758456] - PubMed
Hendolin 1987a {published data only}
    1. Hendolin H, Lahtinen J, Länsimies E, Tuppurainen T, Partanen K. The effect of thoracic epidural analgesia on respiratory function after cholecystectomy. Acta Anaesthesiologica Scandinavia 1987;31:645‐51. - PubMed
Hendolin 1987b {published data only}
    1. Hendolin H, Lahtinen J, Lansimies E, Tuppurainen T. The effect of thoracic epidural analgesia on postoperative stress and morbidity. Annales Chirurgiae et Gynaecologiae 1987;76(4):234‐40. [PUBMED: 3434997] - PubMed
Her 1990 {published data only}
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Hjortso 1986 {published data only}
    1. Hjortso NC, Lund C, Mogensen T, Bigler D, Kehlet H. Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery. Anesthesia and Analgesia 1986;65(10):1033‐6. [PUBMED: 3752551] - PubMed
Houweling 1992 {published data only}
    1. Houweling PL, Ionescu TI. Epidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery. Acta Anaesthesiologica Belgica 1992;43(4):227‐33. [PUBMED: 1300856] - PubMed
Hull 1991 {published data only}
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Inoue 2005 {published data only}
    1. Inoue S, Mitsuhata H, Kawakami T, Shimohata K, Hirabayashi Y, Seo N. Addition of 0.1% bupivacaine to buprenorphine and droperidol in patient‐controlled epidural analgesia improved postoperative pain scores on coughing after gynecological surgery. Journal of Clinical Anesthesia 2005;17(3):167‐71. [PUBMED: 15896581] - PubMed
Jones 2013 {published data only}
    1. Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. The British Journal of Surgery 2013;100(8):1015‐24. [PUBMED: 23696477] - PubMed
Jorgensen 1978 {published data only}
    1. Jörgensen H. Epidural anaesthesia with bupivacaine 0.75% in comparison with bupivacaine 0.5% and mepivacaine 1.5% with adrenaline [Epiduralanaesthesie mit bupivacain 0.75% im vergleich bupivacain 0.5% und mepivacain‐adrenalin 1.5%]. Regional‐Anaesthesie 1978;1:11‐5. - PubMed
Kabon 2003 {published data only}
    1. Kabon B, Fleischmann E, Treschan T, Taguchi A, Kapral S, Kurz A. Thoracic epidural anesthesia increases tissue oxygenation during major abdominal surgery. Anesthesia and Analgesia 2003;97(6):1812‐7. [PUBMED: 14633566] - PubMed
Kajiyama 2004 {published data only}
    1. Kajiyama S, Kobayashi M, Okada Y. [Criteria for postoperative discharge of the patients managed by anesthesiologists in an ambulatory surgery unit]. Masui. The Japanese Journal of Anesthesiology 2004;53(8):882‐7. [PUBMED: 15446676] - PubMed
Kapral 1996 {published data only}
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Kausalya 1994 {published data only}
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Kilbride 1992 {published data only}
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Kiya 2003 {published data only}
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Koganemaru 1996 {published data only}
    1. Koganemaru M, Nakamura T, Takasaki M. Postoperative pain management with continuous epidural infusion of fentanyl‐bupivacaine mixture. Hiroshima Journal of Anesthesia 1996;32(3):267‐9. [CENTRAL: 00352104 ]
Korinek 1985 {published data only}
    1. Korinek AM, Languille M, Bonnet F, Thibonnier M, Sasano P, Lienhart A, et al. Effect of postoperative extradural morphine on ADH secretion. British Journal of Anaesthesia 1985;57:407‐11. - PubMed
Kossman 1982 {published data only}
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Kouraklis 2000 {published data only}
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Krane 1987 {published data only}
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Krane 1989 {published data only}
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Kumar 1993 {published data only}
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Lattermann 2001 {published data only}
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Lattermann 2002 {published data only}
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Lattermann 2003 {published data only}
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Lee 1988 {published data only}
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Lee 1991 {published data only}
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Licker 1995 {published data only}
    1. Licker M, Farinelli C, Klopfenstein CE. Cardiovascular reflexes during anesthesia induction and tracheal intubation in elderly patients: the influence of thoracic epidural anesthesia. Journal of Clinical Anesthesia 1995;7(4):281‐7. [PUBMED: 7546753] - PubMed
Liu 2005 {published data only}
    1. Liu X‐R, Wang Y‐L, Wang C‐Y. Effects of different patient‐controlled analgesic methods on circulative function in hypertensive patients after upper abdominal surgery [Original title available in Chinese characters only]. Chinese Journal of Clinical Rehabilitation 2005;9(2):29‐31. [EMBASE: 2005272688]
Lowson 1994 {published data only}
    1. Lowson SM, Alexander JI, Black AM, Bambridge AD. Epidural diamorphine infusions with and without 0.167% bupivacaine for post‐operative analgesia. European Journal of Anaesthesiology 1994;11(5):345‐52. [PUBMED: 7988577] - PubMed
Madej 1992 {published data only}
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Manikian 1988 {published data only}
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Marco 1989 {published data only}
    1. Marco VJ, Mabrok MM, Arqués Teixidor P, González B, Vidal Claramunt JM, Banõs JE. Caudal morphine for postoperative analgesia in children: randomized study and double‐blind evaluation with bupivacaine and control [Analgesia postoperatoria con morfina por vía caudal cirugía pediádrica: esudio aleatorio y a doble ciego comparado con bupivacaína]. Revista Española de Anestesiología y Reanimación 1989;36:88‐92. - PubMed
Matsunaga 1996 {published data only}
    1. Matsunaga M, Akashi K, Sugano H, Gotoh H, Dan K. Postoperative pain relief and epidural analgesia for open cholecystectomy, laparoscopic cholecystectomy, and gastrectomy. Anesthesia and Resuscitation 1996;32(3):257‐61. [EMBASE: 1997228179]
Mellbring 1983 {published data only}
    1. Mellbring G, Dahlgren S, Reiz S, Sunnegardh O. Thromboembolic complications after major abdominal surgery: effect of thoracic epidural analgesia. Acta Chirurgica Scandinavica 1983;149(3):263‐8. [PUBMED: 6613461] - PubMed
Modig 1981 {published data only}
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Moine 1992 {published data only}
    1. Moine P, Ecoffey C. Caudal block in children: analgesic and ventilatory effects of bupivacaine combined with fentanyl [Bloc caudal chez l'enfant: analgésie et effets respiratoires de l'association bupivacaine‐fentanyl]. Annales Françaises d'Anesthésie et de Réanimation 1992;11:141‐4. - PubMed
Moller 1982 {published data only}
    1. Moller W, Rem J, Brandt R, Kehlet H. Effect of posttraumatic epidural analgesia on the cortisol and hyperglycaemic response to surgery. Acta Anaesthesiologica Scandinavica 1982;26(1):56‐8. [PUBMED: 7072474] - PubMed
Morley 2002 {published data only}
    1. Morley AP, Derrick J, Seed PT, Tan PE, Chung DC, Short TG. Isoflurane dosage for equivalent intraoperative electroencephalographic suppression in patients with and without epidural blockade. Anesthesia and Analgesia 2002;95(5):1412‐8, table of contents. [PUBMED: 12401635] - PubMed
Moselli 2011 {published data only}
    1. Moselli NM, Baricocchi E, Ribero D, Sottile A, Suita L, Debernardi F. Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia. Annals of Surgical Oncology 2011;18(10):2722‐31. [PUBMED: 21479690] - PubMed
Moskovitz 1986 {published data only}
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Muneyuki 1968 {published data only}
    1. Muneyuki M, Ueda Y, Urabe N, Takeshita H, Inamoto A. Postoperative pain relief and respiratory function in man: comparison between intermittent intravenous injections of meperidine and continuous lumbar epidural analgesia. Anesthesiology 1968;29(2):304‐13. - PubMed
Murakami 2009 {published data only}
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Mushambi 1992 {published data only}
    1. Mushambi MC, Rowbotham DJ, Bailey SM. Gastric emptying after minor gynaecological surgery. Anaesthesia 1992;47:297‐9. - PubMed
Naesh 1994 {published data only}
    1. Naesh O, Hindberg I, Friis J, Christiansen C, Pedersen T, Trap‐Jensen J, et al. Platelet activation in major surgical stress: influence of combined epidural and general anaesthesia. Acta Anaesthesiologica Scandinavica 1994;38(8):820‐5. [PUBMED: 7887105] - PubMed
Nandate 2003 {published data only}
    1. Nandate K, Ogata M, Nishimura M, Katsuki T, Kusuda S, Okamoto K, et al. The difference between intramural and arterial partial pressure of carbon dioxide increases significantly during laparoscopic cholecystectomy: the effect of thoracic epidural anesthesia. Anesthesia and Analgesia 2003;97(6):1818‐23. [PUBMED: 14633567] - PubMed
Niiyama 2005 {published data only}
    1. Niiyama Y, Kawamata T, Shimizu H, Omote K, Namiki A. The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery. Canadian Journal of Anaesthesia 2005;52(2):181‐5. [PUBMED: 15684260] - PubMed
Nimmo 1978 {published data only}
    1. Nimmo WS, Littlewood DG, Scott DB, Prescott LF. Gastric emptying following hysterectomy with extradural analgesia. British Journal of Anaesthesia 1978;50:559‐61. - PubMed
Nishikawa 2007 {published data only}
    1. Nishikawa K, Kimura S, Shimodate Y, Igarashi M, Namiki A. A comparison of intravenous‐based and epidural‐based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Journal of Anesthesia 2007;21(1):1‐6. [PUBMED: 17285405] - PubMed
Nishiyama 1991 {published data only}
    1. Nishiyama T, Odaka Y, Hirasaki A, Mikane T, Kobayashi O, Seto K. [Epidural administration of midazolam with saline or bupivacaine for postoperative pain]. Masui. The Japanese Journal of Anesthesiology 1991;40(10):1525‐30. [PUBMED: 1766101] - PubMed
Noreng 1987 {published data only}
    1. Noreng MF, Jensen P, Tjellden NU. Per‐ and postoperative changes in the concentration of serum thyreotropin under general anaesthesia, compared to general anaesthesia with epidural analgesia. Acta Anaesthesiologica Scandinavica 1987;31(4):292‐4. [PUBMED: 3591253] - PubMed
Norris 2001 {published data only}
    1. Norris EJ, Beattie C, Perler BA, Martinez EA, Meinert CL, Anderson GF, et al. Double‐masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001;95(5):1054‐67. [PUBMED: 11684971] - PubMed
O'Connor 2001 {published data only}
    1. O'Connor PJ, Wollin TA, Finucane BT. Controlled Hypotension with combined epidural /general anesthesia reduces bllod loss and transfusion requiremnts compared with general anesthesia alone in radical prostatectomy (conference abstract). Anesthesia and Analgesia. 2001; Vol. 92 S1:S363.
Ohtaka 1991 {published data only}
    1. Ohtaka K, Matsumoto S, Mitsuhata H, Yabe M. [The effect of continuous epidural infusion of a combination of 1% mepivacaine and buprenorphine for post‐operative pain relief]. Masui. The Japanese Journal of Anesthesiology 1991;40(6):942‐8. [PUBMED: 1875542] - PubMed
Olofsson 1997 {published data only}
    1. Olofsson Ch, Ekblom A, Sköldefors E, Wåglund B, Irestedt L. Anesthetic quality during cesarean section following subarachnoid or epidural administration of bupivacaine with or without fentanyl. Acta Anaesthesiologica Scandinavica 1997;41:332‐8. - PubMed
Omar 2009 {published data only}
    1. Omar SH, Radwan KG, Youssif MA, Khafagy HF, Kamal NM, El‐Sabae HH, et al. A non opioid fast track anesthetic regimen for colonic resection. Journal of the Egyptian Society of Parasitology 2009;39(3):849‐64. [PUBMED: 20120751] - PubMed
Osipova 2002 {published data only}
    1. Osipova NA, Petrova VV, Mitrofanov SV, Beresnev VA, Biriukov VI, Bogdanova EV. [Preparations for peripheral and segmental level protection of the patient in the system of general anesthesia and postoperative analgesia] [Sredstva perifericheskogo i segmentarnogo urovnei zashchity patsienta v sisteme obshchei anestezii i posleoperatsionnogo obezbolivaniia.]. Anesteziologiia i Reanimatologiia 2002;47(4):14‐9. [PUBMED: 12462769] - PubMed
Paech 1994 {published data only}
    1. Paech MJ, Westmore MD. Postoperative epidural fentanyl infusion ‐ is the addition of 0.1% bupivacaine of benefit?. Anaesthesia and Intensive Care 1994;22(1):9‐14. [PUBMED: 8160955] - PubMed
Parker 1992 {published data only}
    1. Parker RK, Sawaki Y, White PF. Epidural patient‐controlled analgesia: influence of bupivacaine and hydromorphone basal infusion on pain control after cesarean delivery. Anesthesia and Analgesia 1992;75(5):740‐6. [PUBMED: 1384397] - PubMed
Petring 1984 {published data only}
    1. Petring OU, Adelhøj B, Erin‐Madsen J, Angelo H, Jelert H. Epidural anaesthesia does not delay early postoperative gastric emptying in man. Acta Anaesthesiologica Scandinavia 1984;28:393‐5. - PubMed
Poopalalingam 2003 {published data only}
    1. Poopalalingam R, Chow MY, Wong LT. Patient‐controlled epidural analgesia after thoracic and upper abdominal surgery using sufentanil with and without bupivacaine 0.125%. Singapore Medical Journal 2003;44(3):126‐30. [PUBMED: 12953725] - PubMed
Porter 1997 {published data only}
    1. Porter JS, Bonello E, Reynolds F. The influence of epidural administration of fentanyl infusion on gastric emptying in labour. Anaesthesia 1997;52:1151‐6. [PUBMED: 9485967] - PubMed
Pouzeratte 2001 {published data only}
    1. Pouzeratte Y, Delay JM, Brunat G, Boccara G, Vergne C, Jaber S, et al. Patient‐controlled epidural analgesia after abdominal surgery: ropivacaine versus bupivacaine. Anesthesia and Analgesia 2001;93(6):1587‐92. [PUBMED: 11726450] - PubMed
Rademaker 1992 {published data only}
    1. Rademaker BM, Ringers J, Odoom JA, Wit LT, Kalkman CJ, Oosting J. Pulmonary function and stress response after laparoscopic cholecystectomy: comparison with subcostal incision and influence of thoracic epidural analgesia. Anesthesia and Analgesia 1992;75(3):381‐5. [PUBMED: 1387297] - PubMed
Randalls 1991 {published data only}
    1. Randalls B, Broadway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needle‐through‐needle technique for elective caesarean section. British Journal of Anaesthesia 1991;66:314‐8. [PUBMED: 2015147] - PubMed
Rawal 1984 {published data only}
    1. Rawal N, Sjostrand U, Christoffersson E, Dahlstrom B, Arvill A, Rydman H. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. Anesthesia and Analgesia 1984;63(6):583‐92. [PUBMED: 6233917] - PubMed
Reinhart 1989 {published data only}
    1. Reinhart K, Foehring U, Kersting T, Schaefer M, Bredle D, Hirner A, et al. Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply‐demand relationship. Anesthesia and Analgesia 1989;69(3):360‐9. [PUBMED: 2774232] - PubMed
Reiz 1982 {published data only}
    1. Reiz S, Haggmark S, Rydvall A, Ostman M. Beta‐blockers and thoracic epidural analgesia. Cardioprotective and synergistic effects. Acta Anaesthesiologica Scandinavica. Supplementum 1982;76:54‐61. [PUBMED: 6152883] - PubMed
Renck 1975 {published data only}
    1. Renck H, Edström H. Thoracic epidural analgesia ‐ a double‐blind study between etidocaine and bupivacaine. Acta Anaesthesiologica Scandinavica 1975;Suppl 60:72‐5. [PUBMED: 1101615] - PubMed
Rucci 1985 {published data only}
    1. Rucci FS, Cardamone M, Migliori P. Fentanyl and bupivacaine mixtures for extradural blockade. British Journal of Anaesthesia 1985;57:275‐84. - PubMed
Ryan 1992 {published data only}
    1. Ryan P, Schweitzer SA, Woods RJ. Effect of epidural and general anaesthesia compared with general anaesthesia alone in large bowel anastomoses. A prospective study. The European Journal of Surgery 1992;158(1):45‐9. [PUBMED: 1348641] - PubMed
Saito 1995 {published data only}
    1. Saito Y, Sakura S, Kaneko M, Kosaka Y. Interaction of extradural morphine and lignocaine on ventilatory response. British Journal of Anaesthesia 1995;75(4):394‐8. [PUBMED: 7488475] - PubMed
Sakaguchi 1995 {published data only}
    1. Sakaguchi H, Ikuta Y, Seshita M, Nakano N, Kano T. [Bupivacaine‐fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia]. Masui. The Japanese Journal of Anesthesiology 1995;44(6):786‐94. [PUBMED: 7637152] - PubMed
Salman 2013 {published data only}
    1. Salman N, Durukan AB, Gurbuz HA, Yamali H, Guler L, Ucar HI, et al. Comparison of effects of epidural bupivacaine and intravenous meperidine analgesia on patient recovery following elective abdominal aortic surgery. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 2013;19:347‐52. [PUBMED: 23666275] - PMC - PubMed
Schug 1996 {published data only}
    1. Schug SA, Scott DA, Payne J, Mooney PH, Hagglof B. Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. British Journal of Anaesthesia 1996;76(4):487‐91. [PUBMED: 8652317] - PubMed
Schulte 2008 {published data only}
    1. Schulte E, Hoffmann B, Hohne C, Hofmann M, Olenberger W, Fritz GA. Intraoperative epidural analgesia does not reduce time of postoperative analgesic treatment compared to intravenous analgesia. European Journal of Anaesthesiology 2008; Vol. 25, issue 9:763‐5. [PUBMED: 18400137] - PubMed
Schurizek 1982 {published data only}
    1. Schurizek BA, Rybro L, Petersen TK, Wernberg M. Value of epidural morphine in the treatment of postoperative pain following high laparotomies [En evaluering af epidural morfin i postoperativ smertebehandling af høje laparotomier]. Ugeskr Laeger 1982;144:2638‐41. - PubMed
Scott 1989 {published data only}
    1. Scott NB, Mogensen T, Bigler D, Lund C, Kehlet H. Continuous thoracic extradural 0.5% bupivacaine with or without morphine: effect on quality of blockade, lung function and the surgical stress response. British Journal of Anaesthesia 1989;62:253‐7. - PubMed
Scott 1995 {published data only}
    1. Scott DA, Chamley DM, Mooney PH, Deam RK, Mark AH, Hagglof B. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery ‐ a dose finding study. Anesthesia and Analgesia 1995;81(5):982‐6. [PUBMED: 7486088] - PubMed
Scott 1999 {published data only}
    1. Scott DA, Blake D, Buckland M, Etches R, Halliwell R, Marsland C, et al. A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg/mL fentanyl for seventy‐two hours of postoperative analgesia after major abdominal surgery. Anesthesia and Analgesia 1999;88(4):857‐64. [PUBMED: 10195538] - PubMed
Seeling 1984 {published data only}
    1. Seeling W, Lotz P, Schröder M. Respiratory function after upper abdominal surgery. Continuous epidural analgesia has no advantage over intramuscular piritramide [Untersuchungen zur postoperativen lungenfunktion nach abdominellen eingriffen]. Anaesthesist 1984;33:408‐16. - PubMed
Seeling 1985 {published data only}
    1. Seeling W, Ahnefeld FW, Rosenberg G, Heinrich H, Spilker D. Cardiovascular changes associated with epidural combined with general anaesthesia as compared to neuroleptanaesthesia [Aortofemoraler bifurkationsbypass ‐ der einfluss des anaesthesieverfahrens (NLA, thorakale kontinuerliche katheterperiduralanaesthesie) auf kreislauf, atmung und stoffwechsel]. Anaesthesist 1985;34:217‐28. - PubMed
Seow 1976 {published data only}
    1. Seow LT, Chiu HH, Tye CY. Clinical evaluation of etidocaine in continuous caudal analgesia for pelvic floor repair and post‐operative pain relief. Anaesthesia and Intensive Care 1976;4:239‐44. - PubMed
Seow 1982 {published data only}
    1. Seow LT, Lips FJ, Cousins MJ, Mather LE. Lidocaine and bupivacaine mixtures for epidural blockade. Anesthesiology 1982;56:177‐83. - PubMed
Shir 1995 {published data only}
    1. Shir Y, Raja SN, Frank SM, Brendler CB. Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anaesthesia. Urology 1995;45(6):993‐9. [PUBMED: 7771032] - PubMed
Sinclair 1984 {published data only}
    1. Sinclair CJ, Scott DB. Comparison of bupivacaine and etidocaine in extradural blockade. British Journal of Anaesthesia 1984;56:147‐53. - PubMed
Smeets 1993 {published data only}
    1. Smeets HJ, Kievit J, Dulfer FT, Kleef JW. Endocrine‐metabolic response to abdominal aortic surgery: a randomized trial of general anesthesia versus general plus epidural anesthesia. World Journal of Surgery 1993;17(5):601‐6; discussion 606‐7. [PUBMED: 8273381] - PubMed
Smith 1996 {published data only}
    1. Smith AJ, Haynes TK, Roberts DE, Harmer M. A comparison of opioid solutions for patient‐controlled epidural analgesia. Anaesthesia 1996;51(11):1013‐7. [PUBMED: 8943590] - PubMed
Spence 1971 {published data only}
    1. Spence AA, Smith G. Postoperative analgesia and lung function: a comparison of morphine with extradural block. British Journal of Anaesthesia 1971;43(2):144‐8. [PUBMED: 5550845] - PubMed
Stamenkovic 2008 {published data only}
    1. Stamenkovic DM, Geric V, Slavkovic Z, Raskovic J, Djordjevic M. Combined spinal‐epidural analgesia vs. intermittent bolus epidural analgesia for pain relief after major abdominal surgery. A prospective, randomised, double‐blind clinical trial. International Journal of Clinical Practice 2008;62(2):255‐62. [PUBMED: 18028385] - PubMed
Stamenkovic 2009 {published data only}
    1. Stamenkovic D, Geric V, Djordjevic M, Raskovic J, Slavkovic Z, Randjelovic T, et al. Subarachnoid morphine, bupivacaine and fentanyl as part of combined spinal‐epidural analgesia for low anterior resection. A prospective, randomised, double‐blind clinical trial. Anaesthesia and Intensive Care 2009;37(4):552‐60. [PUBMED: 19681410] - PubMed
Stehr‐Zirngibl 1997 {published data only}
    1. Stehr‐Zirngibl S, Doblinger L, Neumeier S, Zirngibl H, Taeger K. [Intravenous versus thoracic‐epidural patient‐controlled analgesia following extended abdominal or thoracic surgery] [Intravenose versus thorakale‐epidurale patienten‐kontrollierte Analgesie bei ausgedehnten Oberbauch‐und Thoraxeingriffen]. Der Anaesthesist 1997;46 Suppl 3:S172‐8. [PUBMED: 9412274] - PubMed
Stenseth 1994 {published data only}
    1. Stenseth R, Bjella L, Berg EM, Christensen O, Levang OW, Gisvold SE. Thoracic epidural analgesia in aortocoronary bypass surgery. I: Haemodynamic effects. Acta Anaesthesiologica Scandinavica 1994;38(8):826‐33. [PUBMED: 826‐33] - PubMed
    1. Stenseth R, Bjella L, Berg EM, Christensen O, Levang OW, Gisvold SE. Thoracic epidural analgesia in aortocoronary bypass surgery. II: Effects on the endocrine metabolic response. Acta Anaesthesiologica Scandinavica 1994;38(8):834‐9. [PUBMED: 7887107] - PubMed
Sutcliffe 1996 {published data only}
    1. Sutcliffe NP, Mostafa SM, Gannon J, Harper SJ. The effect of epidural blockade on gastric intramucosal pH in the peri‐operative period. Anaesthesia 1996;51(1):37‐40. [PUBMED: 8669564] - PubMed
Suttner 2005 {published data only}
    1. Suttner S, Lang K, Piper SN, Schultz H, Rohm KD, Boldt J. Continuous intra‐ and postoperative thoracic epidural analgesia attenuates brain natriuretic peptide release after major abdominal surgery. Anesthesia and Analgesia 2005;101(3):896‐903, table of contents. [PUBMED: 16116011] - PubMed
    1. [No authors listed]. Continuous intra‐ and postoperative thoracic epidural analgesia attenuates brain natriuretic peptide release after major abdominal surgery: retraction. Anesthesia and Analgesia 2011;112(5):1109. [PUBMED: 21451068] - PubMed
Takahashi 2005 {published data only}
    1. Takahashi W, Okazaki J, Yamamoto T, Nishino T. [Effects of simultaneous epidural administration of ropivacaine and morphine on the post‐operative pain in the gynecologic patients]. Masui. The Japanese Journal of Anesthesiology 2005;54(2):126‐32. [PUBMED: 15747505] - PubMed
Thörn 1992 {published data only}
    1. Thörn SE, Wattwil M, Näslund I. Postoperative epidural morphine, but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy. Regional Anesthesia 1992;17:91‐4. - PubMed
Thörn 1996 {published data only}
    1. Thörn SE, Wichbom G, Philipson L, Leissner P, Wattwil M. Myoelectric activity in the stomach and duodenum after epidural administration of morphine or bupivacaine. Acta Anaesthesiologica Scandinavica 1996;40:773‐8. - PubMed
Tikuisis 2009 {published data only}
    1. Tikuisis R, Miliauskas P, Samalavicius NE, Zurauskas A, Sruogis A. Epidural and general anesthesia versus general anesthesia in radical prostatectomy. Medicina (Kaunas, Lithuania) 2009;45(10):772‐7. [PUBMED: 19996663] - PubMed
Torda 1995 {published data only}
    1. Torda TA, Hann P, Mills G, Leon G, Penman D. Comparison of extradural fentanyl, bupivacaine and two fentanyl‐bupivacaine mixtures for pain relief after abdominal surgery. British Journal of Anaesthesia 1995;74:35‐40. - PubMed
Traynor 1982 {published data only}
    1. Traynor C, Paterson JL, Ward ID, Morgan M, Hall GM. Effects of extradural analgesia and vagal blockade on the metabolic and endocrine response to upper abdominal surgery. British Journal of Anaesthesia 1982;54(3):319‐23. [PUBMED: 7039644] - PubMed
Tsuji 1983 {published data only}
    1. Tsuji H, Asoh T, Takeuchi Y, Shirasaka C. Attenuation of adrenocortical response to upper abdominal surgery with epidural blockade. The British Journal of Surgery 1983;70(2):122‐4. [PUBMED: 6824898] - PubMed
Tsuji 1983a {published data only}
    1. Tsuji H, Shirasaka C, Asoh T, Takeuchi Y. Influences of splanchnic nerve blockade on endocrine‐metabolic responses to upper abdominal surgery. The British Journal of Surgery 1983;70(7):437‐9. [PUBMED: 6307458] - PubMed
Tsuji 1987 {published data only}
    1. Tsuji H, Shirasaka C, Asoh T, Uchida I. Effects of epidural administration of local anaesthetics or morphine on postoperative nitrogen loss and catabolic hormones. The British Journal of Surgery 1987;74(5):421‐5. [PUBMED: 3594144] - PubMed
Uchida 1988 {published data only}
    1. Uchida I, Asoh T, Shirasaka C, Tsuji H. Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique. The British Journal of ´Surgery 1988;75(6):557‐62. [PUBMED: 3293693] - PubMed
Vedrinne 1989 {published data only}
    1. Vedrinne C, Vedrinne JM, Guiraud M, Patricot MC, Bouletreau P. Nitrogen‐sparing effect of epidural administration of local anesthetics in colon surgery. Anesthesia and Analgesia 1989;69(3):354‐9. [PUBMED: 2774231] - PubMed
Virlos 2010 {published data only}
    1. Virlos I, Clements D, Beynon J, Ratnalikar V, Khot U. Short‐term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery. The British Journal of Surgery 2010;97(9):1401‐6. [PUBMED: 20603849] - PubMed
von Ungern‐Sternberg 2005 {published data only}
    1. Ungern‐Sternberg BS, Regli A, Reber A, Schneider MC. Effect of obesity and thoracic epidural analgesia on perioperative spirometry. British Journal of Anaesthesia 2005;94(1):121‐7. [PUBMED: 15486001] - PubMed
Wang 2013 {published data only}
    1. Wang P, Wang HW, Zhong TD. Influence of different anesthesia on liver and renal function in elderly patients undergoing laparoscopic colon or rectal resection. Hepato‐Gastroenterology 2013;60(121):79‐82. [PUBMED: 22773302] - PubMed
Wessen 1994 {published data only}
    1. Wessen A, Persson PM, Nilsson A, Hartvig P. Clinical pharmacokinetics of propofol given as a constant‐rate infusion and in combination with epidural blockade. Journal of Clinical Anesthesia 1994;6(3):193‐8. [PUBMED: 7914736] - PubMed
White 1979 {published data only}
    1. White WD, Pearce DJ, Norman J. Postoperative analgesia: a comparison of intravenous on‐demand fentanyl with epidural bupivacaine. British Medical Journal 1979;2(6183):166‐7. [PUBMED: 466335] - PMC - PubMed
Wiebalck 1997 {published data only}
    1. Wiebalcht A, Brodner G, Aken HV. The effect of adding sufentanil to bupivacaine for postoperative patient‐controlled epidural analgesia. Anesthesia and Analgesia 1997;85:124‐9. [PUBMED: 9212134] - PubMed
Wolf 1993 {published data only}
    1. Wolf AR, Hughes D. Pain relief for infants undergoing abdominal surgery: comparison of infusions of i.v. morphine and extradural bupivacaine. British Journal of Anaesthesia 1993;70:10‐6. - PubMed
Wright 1992 {published data only}
    1. Wright PMC, Allen RW, Moore J, Donnelly JP. Gastric emptying during lumbar extradural analgesia in labour: effect of fentanyl supplementation. British Journal of Anaesthesia 1992;68:248‐51. - PubMed
Wu 2000 {published data only}
    1. Wu CT, Yeh CC, Yu JC, Lee MM, Tao PL, Ho ST, et al. Pre‐incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre‐emptive analgesia for upper abdominal surgery. Acta Anaesthesiologica Scandinavica 2000;44(1):63‐8. [PUBMED: 10669274] - PubMed
Yeh 2005 {published data only}
    1. Yeh CC, Jao SW, Huh BK, Wong CS, Yang CP, White WD, et al. Preincisional dextromethorphan combined with thoracic epidural anesthesia and analgesia improves postoperative pain and bowel function in patients undergoing colonic surgery. Anesthesia and Analgesia 2005;100(5):1384‐9. [PUBMED: 15845691] - PubMed
Yorozu 1996 {published data only}
    1. Yorozu T, Morisaki H, Kondoh M, Toyoda Y, Miyazawa N, Shigematsu T. Epidural anaesthesia during upper abdominal surgery provides better postoperative analgesia. Journal of Anaesthesia 1996;10(1):10‐5. [PUBMED: 23839545] - PubMed
Yorozu 1997 {published data only}
    1. Yorozu T, Morisaki H, Kondoh M, Tomizawa K, Satoh M, Shigematsu T. Epidural anesthesia during hysterectomy diminishes postoperative pain and urinary cortisol release. Journal of Anesthesia 1997;11(4):260‐4. [EMBASE: 1998011089] - PubMed
Yuceyar 2004 {published data only}
    1. Yuceyar L, Erolcay H, Konukoglu D, Bozkurt AK, Aykac B. Epidural anesthesia may attenuate lipid peroxidation during aorto‐femoral surgery. Canadian Journal of Anaesthesia 2004;51(5):465‐71. [PUBMED: 15128632] - PubMed
Zingg 2009 {published data only}
    1. Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surgical Endoscopy 2009;23(2):276‐82. [PUBMED: 18363059] - PubMed

References to studies awaiting assessment

Baumunk 2014 {published data only}
    1. Baumunk D, Strang CM, Kropf S, Schafer M, Schrader M, Weikert S, et al. Impact of thoracic epidural analgesia on blood loss in radical retropubic prostatectomy. Urologia Internationalis 2014;93(2):193‐201. [PUBMED: 24851943] - PubMed
Chen 2015 {published data only}
    1. Chen WK, Ren L, Wei Y, Zhu DX, Miao CH, Xu JM. General anesthesia combined with epidural anesthesia ameliorates the effect of fast‐track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients. International Journal of Colorectal Disease 2015;30(4):475‐81. [PUBMED: 25579161] - PubMed
Enohata 2014 {published data only}
    1. Enohata K, Hasegawa‐Moriyama M, Kuniyoshi T, Kanmura Y. [Plasma levels of anti‐oxidant markers during general anesthesia‐‐a comparison between remifentanil‐ and epidural‐based anesthesia]. Masui. The Japanese Journal of Anesthesiology 2014;63(3):328‐32. [PUBMED: 24724445] - PubMed
Khoronenko 2014 {published data only}
    1. Khoronenko VE, Baskakov DS. [Role of migraine history in the development of postoperative nausea and vomiting in patients undergoing general and combined general‐epidural anesthesia]. Anesteziologiia i Reanimatologiia 2014;59(2):41‐4. [PUBMED: 25055492] - PubMed
Kun 2014 {published data only}
    1. Kun L, Tang L, Wang J, Yang H, Ren J. Effect of combined general/epidural anesthesia on postoperative NK cell activity and cytokine response in gastric cancer patients undergoing radical resection. Hepato‐Gastroenterology 2014;61(132):1142‐7. [PUBMED: 26158178] - PubMed
Li 2015 {published data only}
    1. Li JM, Shao JL, Zeng WJ, Liang RB. General/epidural anesthesia in combination preserves NK cell activity and affects cytokine response in cervical carcinoma patients undergoing radical resection: a cohort prospective study. European Journal of Gynaecological Oncology 2015;36(6):703‐7. [PUBMED: 26775356] - PubMed
Orsolya 2015 {published data only}
    1. Orsolya M, Attila‐Zoltan M, Gherman V, Zaharie F, Bolboaca S, Chira C, et al. The effect of anaesthetic management on neutrophil gelatinase associated lipocalin (NGAL) levels after robotic surgical oncology. Journal of the Balkan Union of Oncology 2015;20(1):317‐24. [PUBMED: 25778333] - PubMed
Pan 2015 {published data only}
    1. Pan YS, Hu YF, Tian FB, Xu K. Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study. International Journal of Clinical and Experimental Medicine 2015;8(6):9862‐8. [PUBMED: 26309669] - PMC - PubMed
Satsuta 2015 {published data only}
    1. Satsuta SV, Bondarev RV. Anesthesia via sevofluranum with prolonged epidural blockade decreasing complications during and after laparoscopic sanitation in patients with abdominal sepsis. Surgical Endoscopy and Other Interventional Techniques 2015;29:598. [CENTRAL: 01080313]
Sayan 2015 {published data only}
    1. Sayan H, Aydogan MS, Bicakcioglu M, Toprak HI, Isik B, Yilmaz S. Effects of thoracic epidural anesthesia on liver blood flow and indocyanine green clearance test in living‐donor liver transplantation: a prospective, randomized, double‐blind study. Transplantation Proceedings 2015;47(5):1462‐5. [PUBMED: 26093743] - PubMed
Sen 2014 {published data only}
    1. Sen I, Thomas S, Arya VK, Minz M. Preinduction hemodynamic fluctuations in renal transplant recipients ‐ comparison of two combined anesthesia regimens. Saudi Journal of Kidney Diseases and Transplantation 2014;25(6):1232‐9. [PUBMED: 25394440] - PubMed
Sidiropoulou 2014 {published data only}
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Watanabe 2014 {published data only}
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References to ongoing studies

Li 2015a {published data only}
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Additional references

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References to other published versions of this review

Guay 2016
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