Correspondence  |   August 2016
Epidurals and Chronic Postsurgical Pain: Is It Lack of Evidence or Poor Design?
Author Notes
  • Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (E.S.S.). eric.schwenk@jefferson.edu
  • (Accepted for publication April 28, 2016.)
    (Accepted for publication April 28, 2016.)×
Article Information
Correspondence
Correspondence   |   August 2016
Epidurals and Chronic Postsurgical Pain: Is It Lack of Evidence or Poor Design?
Anesthesiology 8 2016, Vol.125, 439-440. doi:10.1097/ALN.0000000000001191
Anesthesiology 8 2016, Vol.125, 439-440. doi:10.1097/ALN.0000000000001191
We read with great interest the large, retrospective database review of perioperative epidural use for abdominal surgery by Ladha et al.1  We agree that studying anesthetic techniques that might have an impact on the incidence of persistent postsurgical pain is an important area, and is one in which large, well-controlled studies are lacking. Indeed, the large sample population was a strength of the study. However, we have serious concerns about the design of the study. First, and perhaps most importantly, the study’s premise that a single intervention alone, regardless of how it was administered and in what context, would lead to decreased long-term opioid consumption is flawed. In the meta-analysis cited by the authors that examined the effects of regional anesthesia on chronic postsurgical pain,2  that study’s authors could find only a single prospective trial that reported positive results comparing epidural analgesia to placebo after abdominal surgery. That single study3  used preventive epidural analgesia in a multimodal regimen to decrease chronic postsurgical pain, while equivocal results were found in another that did not use multimodal analgesia.4  It is not surprising, then, that Ladha et al. found no benefit. They did not report on the presence or absence of multimodal analgesia, which would impact their results.
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