Does the use of epidural analgesia in open gynaecological oncology surgery impact patient outcomes. A Narrative Review

The use of epidural analgesia (EA) for major open gynaecological oncology surgery remains controversial. While it is generally regarded as providing optimal pain relief compared to systemic opioids, the associated complications, adverse events, and technical issues are cause for concern. Furthermore, there is evidence to suggest that EA hampers early mobilisation, potentially increasing length of stay (LOS). The recent Enhanced Recovery After Surgery (ERAS) guidelines for gynaecological oncology surgery from April 2023 prefer alternative strategies for pain relief such as wound infiltration. The main reason is fear of significant complications associated with neuraxial analgesia. We included all articles published between 2000 and 2023 using the search terms epidural’ ‘gynaecology’ ‘oncology’ ‘surgery’. Our current literature search aimed to identify the most robust evidence regarding the use of EA in gynaecological surgery. We sought to evaluate a comprehensive assessment of efficacy, safety, and overall impact on patient outcomes of EA in gynaecological surgery. This effort was focused on understanding the nuances of how EA performs in this specific context and how it compares to other pain management strategies. Despite our comprehensive search, most of the data remains inconclusive, and there is significant discrepancy among studies and guidelines. This inconsistency underscores the need for further research to clarify the effectiveness and safety of EA in open gynaecological surgery. The conflicting evidence highlights the challenges in establishing a consensus and suggests that current recommendations may not fully capture the complexities of its clinical use in this specific setting. More research regarding complication and success rates as well as considering potential benefits in specific patient populations are needed.