Use of thoracic epidural anaesthesia for thoracic surgery and its effect on pulmonary function

Pulmonary complications following thoracic surgery significantly contribute to peri-operative morbidity and mortality. This chapter discusses some pathophysiological aspects of thoracic surgery, the effects of epidural anaesthesia on pulmonary function and its implications for use of thoracic epidural anaesthesia after thoracic surgery. A favourable effect of epidural anaesthesia on incidence of pulmonary morbidity was recently demonstrated in a meta-analysis involving a broad spectrum of surgical procedures. There is less evidence that the use of thoracic epidural anaesthesia techniques is associated with fewer respiratory complications in patients undergoing thoracotomy. However, thoracic epidural anaesthesia provides excellent analgesia after thoracotomy, particularly if local anaesthetics are combined with opioids. In addition, decreased length of stay on an intensive care unit and reduced hospital stay could be demonstrated if thoracic epidural anaesthesia was used in cardiac or thoracic surgical patients.