It has been demonstrated that there is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for caesarean delivery and colon surgery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. The author also argues that although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique and that the number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The main conclusion is that the decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition.

In my opinion, preoperative control of Central Sensitization by gabapentinoids and intra-operative low-dose of Ketamine has drastically changed the scenario. In this new context, wound infiltration techniques and their modifications complete the interventions to guarantee an optimal acute pain control without the need for epidural catheter.

Regional anesthesia specially the epidural. Analgesia. Has. Benn proved to be the most effective technique for postoperative pain unless contraindicated

Epidural analgesia with a catheter is great technique but only if it works! So many epidurals are not covering complete the painful area, are dislocated or inproperly used. I feel that for one-sided abdominal operations, TAP blocks or rectus sheath blocks with a catheter are good alternative option.

Epidurals Need to be site specific for optimal effect

Less effective in the hands of inexperienced and can be

Dangerous when poor quality equipment is used

by the inexperienced

There is a learning curve

Experience is overwhelmingly in favor of epidurals anywhere in the spinal canal

This is the latest review on this topic.

http://www.intechopen.com/books/pain-and-treatment

Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council

Recommendation 26

The panel recommends that clinicians offer neuraxial analgesia for major thoracic and abdominal procedures, particularly in patients at risk for cardiac complications, pulmonary complications, or prolonged ileus (strong recommendation, high-quality evidence). Epidural analgesia with local anesthetics (with or without opioids) or spinal analgesia (intrathecal opioid) in adults and children is associated with lower postoperative pain scores or decreased rescue analgesic use compared with placebo injections or systemic opioid analgesia in patients who underwent a variety of surgeries.

Epidural or spinal analgesia might be associated with a decreased risk of postoperative mortality, venous thromboembolism, myocardial infarction, pneumonia, and respiratory depression, and decreased duration of ileus versus systemic analgesia, although such benefits were primarily observed in older trials that might have used outdated systemic analgesia techniques.Therefore, clinicians should routinely consider use of epidural or spinal analgesia for management of postoperative pain in patients who undergo major thoracic and abdominal procedures, cesarean section, and hip and lower extremity surgeries, particularly in patients at risk for cardiac complications, pulmonary complications, or prolonged ileus. A potential advantage of epidural analgesia is that it can be performed as a continuous infusion or as PCA with local anesthetics, whereas spinal analgesia is limited to a single dose of opioids. The coadministration of epidural clonidine with local anesthetics might be associated with improved analgesia in the postoperative period compared with epidural local anesthetic alone, but there is insufficient evidence to recommend its routine use and it is associated with increased risk of hypotension.

Yes,but bilateral ultrasound guided erector spinae block or Paravertibral block with catheter insitu can also give equivalent pain relief....

Epidural anesthesia for peri-operative analgesia is indeed an approach we have become more comfortable and confident with due to the decades of practice. However, with the recent advancements and research various peripheral nerve blocks and regional approaches are gaining popularity. For example quadratus lumborum block, paravertebral blocks, rectus sheath and erector spinae blocks are increasingly being used for pain relief in thoracic and abdominal surgeries. Similarly PENG block, adductor canal block and sciatic blocks are utilized for lower limb surgeries. These do offer better hemodynamic profiles and decreased risk of complications than epidural block. The common practical disadvantages of epidural involves catheter migration, inadequate dermatome coverage and high cost apart from others. Despite all above, to discard epidural as the most effective and popular mode (rather than using the term "GOLD STANDARD")for peri-operative analgesia, a strong evidence base needs to be gathered.