Introduction: Epidural analgesia is a popular approach to postoperative and labor pain. Neurotoxicity and drug-specific systemic side effects can occur after epidural administration. As an increasing number of epidural drugs are studied and clinically applied, drug efficacy and safety evaluation are crucial.

Areas covered: In this narrative review, the authors provide a thorough overview on the safety of the most widely used epidural drugs, focusing on potential neurotoxicity, side effects, and complications in the adult, non-pregnant population. A combined text and MeSH heading search strategy was used to identify relevant publications.

Expert opinion: The search for the ideal epidural medication has resulted in a surplus of drug combinations with extensive heterogeneity amongst studies, while the value of investigating these is not always evident. Epidural drugs pose a potential threat of neurotoxicity and other side effects. Consequently, we should pursue safe epidural drug administration to patients and refrain from drugs with minimal proven benefit. Also, studies should compare epidural with systemic application. Because why use a drug epidurally, which can be safely used systemically? Future research should focus on providing solid evidence regarding efficacy of epidural analgesia compared to new and already existing modalities and optimizing presently used medicinal regimens.

简介：硬膜外镇痛是一种治疗术后和分娩痛的流行方法。硬膜外给药后可能会发生神经毒性和药物特异性全身副作用。随着越来越多的硬膜外药物的研究和临床应用，药物疗效和安全性评估至关重要。

涉及的领域：在这篇叙述性综述中，作者对最广泛使用的硬膜外药物的安全性进行了全面的概述，重点研究了成年，未怀孕人群的潜在神经毒性，副作用和并发症。结合使用文本和MeSH标题搜索策略来识别相关出版物。

专家意见：在研究中，寻求理想的硬膜外药物导致过多的药物组合具有广泛的异质性，而研究这些药物的价值并不总是显而易见的。硬膜外药物可能会引起神经毒性和其他副作用。因此，我们应该对患者进行安全的硬膜外药物管理，并避免使用已证实的获益最小的药物。此外，研究应将硬膜外麻醉与全身应用进行比较。因为为什么要硬膜外使用一种可以全身安全使用的药物？未来的研究应集中在提供与新的和现有的方法相比有关硬膜外镇痛效果的可靠证据，并优化目前使用的药物治疗方案。