Thoracic epidural analgesia in cardiac surgery: impact on postoperative morbidity

Application of thoracic epidural analgesia in cardiac surgery offers several advantages but requires an adaptation of the postoperative clinical pathways. These adaptations are mandatory to minimize the risks related to the use of epidural catheters in cardiac anesthesia and to gain the maximum benefits from the technique. It involves lower doses of opioids, aggressive temperature and fluid management, strict anticoagulation guidelines, and clear staff information. Thoracic epidural analgesia has the potential to improve outcome after cardiac surgery: better analgesia, better postoperative respiratory physiotherapy, better pulmonary outcome, better myocardial protection, attenuation of stress response, and possibly shorter hospital stay. This potential needs to be supported by a change in all aspects of postoperative patient management and the creation of new clinical pathways.