Indications
The evidence is that epidurals provide excellent analgesia when they work. They have an established role in obstetrics. Their exact role in other surgery or trauma is controversial.
Labour
Maternal Request
Obstetrician Request
e.g. Induction of labour, High Risk Pregnancy e.g. Twins, Breech, Preeclampsia
Obesity
Obese women pose a challenge to the anaesthetist. They are at increased risk of needing obstetric intervention. (Both caesarean and instrumental delivery.)
Regional anaesthesia may be technically difficult whilst emergency general anaesthesia puts the patient at risk of difficult intubation, difficult ventilation or aspiration.
Inserted early, a working epidural can be provide analgesia and can then be "topped up" in the event of obstetric intervention.
Lower limb surgery
Vascular Surgery
Epidurals May improve distal blood flow.
Amputations
Epidurals May reduce the incidence of severe phantom limb pain but the evidence is inconclusive.
Thoracic Surgery
Chest Trauma
Epidurals may aid in deep breathing, coughing and chest physiotherapy.
Surgery
Thoracic surgery is often painful and is associated with a high rate of chronic postoperative pain. Good peri-operative pain relief may reduce the rate of chronic pain.
Abdominal Surgery
Epidurals may improve respiratory function after major abdominal surgery and may reduce respiratory failure rates in patients with severe underlying respiratory disease.