Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?

Background: A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post‐operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high‐risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post‐operative costs of intensive care in patients receiving epidural or intravenous analgesia. Methods: Clinical data and rates of post‐operative complications were extracted from a previously reported trial following thoraco‐abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care. Results: Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros/patient, were outweighed by lower post‐operative costs of intensive care 5,571 vs. 7,921 Euros/patient (NS). Conclusion: Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post‐operative care following major surgery.