• Marija Tošić Mijajlović Dom zdravlja dr Simo Milosevic, Cukarica, Beograd


epidural anesthesia, surgery, analgesia


Modern anaesthesiological practice enabled the rapid development of modern surgery. Over the last few years EA become one of the most popular anaesthetical procedure for operations in: vascular, cardiothoracic and abdominal surgery.

This type of anaesthesia is a central neuro blocade, and it begins by injecting the solution of local anesthetic in the epidural space of the thoracic, lumbar or sacral part of the spine. By placing a catheter into the epidural space opens the possibility of the continues analgesic effect.

Because of its advantages EA is more often used as a single procedure or in combination with other anaesthetical procedures in cardiovascular surgery, especially in peripheral vascular surgery.

The advatages, which positively affect the outcome oh treatment, are: the simpatic blocade that result in peripheral vasodilatation, conductive bloc which gives the complete analgesia and decreased neuro-endocrine stress response.

EA significantly decreases the possibility for postoperative complications (nausea, vomitus, pain) that can postpone the dismission for ambulatory patients.

Epidural anesthesia is usually a safe method, but, as in all medical procedures, side efects and complication may occur. In modern anesthesiological practice it is important to prevent them, recognise them in time and treat them adequatly to prevent more serious consequences.


Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003 Nov;238(5):663-73. doi: 10.1097/01.sla.0000094300.36689.ad. PMID: 14578727; PMCID: PMC1356143.

CN Adams, Spinal Anaesthesia and the Contributions of Corning and Bier, Anaesthesia & Intensive Care Medicine, Volume 4, Issue 10, 2003, Page i, ISSN 1472-0299, https://doi.org/10.1383/anes.

Clemente A, Carli F: The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal system. Minerva Anestesiol 2008;74: 549-63

Fitzpatrick K, Dueg M : Anesthesia outside the operating room. In Anesthesia secrets eds. Duke J, Rosenberg SG.,Philadelphia: Hanley & Beltus, Inc. St. Louis: Mosby; 1996: 420-3

Konstantinović S, Janković R: Osnovi anestezije. U: Hirurgija urednik Višnjić M. Prosveta, Niš, 2005; pp: 61-8.

Cohen E. The Practice of Thoracic Anesthesia Lippincott, 1995.

Waurick K, Waurick R. Epiduralanästhesie - Geschichte und Technik der Epiduralanästhesie [History and Technique of Epidural Anaesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015 Jul;50(7-8):476-82; quiz 483. German. doi: 10.1055/s-0041-100845. Epub 2015 Jul 31. PMID: 26230893.

Mulroy MF.: Regional Anesthetic Techniques. In: Anesthesia Ambulatory Surgery edited White PF., Bosten Litle, Brown, 1994: 81-98.

James C. Crews, NEW DEVELOPMENTS IN EPIDURAL ANESTHESIA AND ANALGESIA, Anesthesiology Clinics of North America, Volume 18, Issue 2, 2000, Pages 251-266, ISSN 0889-8537, https://doi.org/10.1016/S0889-8537(05)70163-2.

. Bonnet F, Marret E: Postoperative pain management and outcome after surgery. Best Pract Clin Anesthesiol 2009; 21: 99-107.

Brendan T. Finucane, ed.: Complications of regional surgery. Springer, NY, 2007.

Myles PS, Power I, Jamrozik K: Epidural block and outcome after major surgery. Med J Aust 2002; 177: 536-7.

Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques: An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2017; 126:585–601 doi: https://doi.org/10.1097/ALN.0000000000001521

Masataka YOKOYAMA, Indication and Contraindication of Epidural Anesthesia, The Journal of Japan Society for clinical anesthesia, 2009 Volume 29 Issue 3 Pages 239-248 https://doi.org/10.2199/jjsca.29.239

Bode RH, Lewis KP, Zarich SW et al. Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology 1996; 84: 3 -13

Lombardo L, Ruggia O, Crocellà L, Masoero G, Foti M, Mambrini S, Palombo D, Melchiorri C, Lupo M, Pera A: Epidural plus general anesthesia vs general anesthesia alone for elective aortic surgery: effects on gastric electrical activity and serum gastrin secretion. Minerva Anestesiol 2009; 75: 109-15

Visser WA, Lee RA, Gielen MJ: Factors affecting the distribution of neural blocade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracis epidural anesthesia. Anesth Analg 2008; 107: 708-21.

Benumof JL: Anesthesia for Thoracic Shurgery. 2nd. Ed. Sounders, 1995.

Santeularia Vergés MT, Català Puigbò E, Genové Cortada M, Revuelta Rizo M, Moral García MV: New trends in the treatment of postoperative pain in general and gastrointestinal surgery. Cir Esp 2009; 86: 63-71

Allen W. Burton et all, Epidural and Intrathecal Analgesia Is Effective in Treating Refractory Cancer Pain, Pain Medicine, Volume 5, Issue 3, September 2004, Pages 239–247, https://doi.org/10.1111/j.1526-4637.2004.04037.x

White PF, ed.: Anesthesia for Ambulatory Surgery. International Anesthesia Clinics. Boston: Little Brown & Company, 1994; 1-16.






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