While early studies claimed a reduction in morbidity with patient-controlled analgesic pumps, more recent studies with better controls show that this advantage is relatively small. Ambulation may be improved, but there is no effect on the stress response. However, epidural analgesia, particularly with opioids and local anesthetics, reduces the hormonal response to stress, oxygen consumption, and cardiac work, especially in high-risk patients ( Liu e,L§L 1995). Thoracic epidural analgesia is required to blunt the stress response for abdominal surgery and must be maintained both intra- and postoperatively. This leads to benefits with reduction of cardiac and pulmonary morbidity, a lower incidence of deep vein thromboses, earlier return of gastrointestinal function, and improved graft patency after vascular surgery.
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