Is epidural analgesia in colorectal surgery a relic of the past? (narrative review)

Introduction. Regional anesthesia is an important component of adequate analgesia in colorectal surgery. Currently, epidural analgesia (EA) is considered the «gold standard» of regional anesthesia in colorectal surgery. EA has a number of contraindications and complications that limit its use in anesthesiological practice. The article presents possible alternatives to EA that could be used as part of multimodal analgesia in colorectal surgery. The key role is assigned to fascial-sheath blocks: TAP block and QL block.

The objective was to analyze the literature on the use of epidural anesthesia, TAP block, and QL block in colorectal surgery.

Materials and methods. The literature was searched using PubMed, MEDLINE, Google Scholar, and eLibrary databases for the period 2008–2024. The keywords for the search were: Regional anesthesia, colorectal surgery, epidural anesthesia, TAP-block, QL-block, regional anesthesia, colorectal surgery, epidural anesthesia, TAP block, QL block.

Results. 44 articles published from 2008 to 2024 were analyzed. The predominant number of articles (39) are presented by foreign sources, which indicates a low degree of study of the problem among domestic researchers.

Conclusions. EA is traditionally considered the «gold standard» of regional anesthesia in colorectal surgery. It is impractical to recommend the TAP block and the QL block as an equivalent replacement for EA. It is necessary to conduct new, larger-scale studies reflecting the effectiveness of fascial-sheath blocks in colorectal surgery.

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