Continuous epidural analgesia can be beneficial for postoperative pain control. Perioperatively, it may attenuate the physiologic response to surgery. This potentially decreases morbidity and mortality when compared with systemic opioids by improving gastrointestinal function, decreasing pulmonary complications, decreasing myocardial infarctions, improving mental status, and decreasing thrombotic events. It is indicated for patients undergoing almost all surgeries extending from the thorax to the lower extremities. There are few contraindications; these include patient refusal, coagulopathy, and local infection at the insertion site. Although continuous epidural analgesia is quite effective when properly managed, care must be taken to balance the beneficial effects with the many possible side effects.

There are several choices of medications and medication combinations that can be used for epidural infusion. Local anesthetics can produce an excellent sensory block but may also cause a motor block, hypotension, and/or bradycardia. Opioids produce good analgesia but may be associated with nausea, vomiting, urinary retention, and pruritus. Therefore, for postoperative pain control, the combination of a local anesthetic and an opioid is often the best choice. There are many different local anesthetics and opioids that are available and the choice of what to use should be tailored to the patient and situation. Adjuvant medications include clonidine and epinephrine, but their utility has not been proven to be effective.