A survey of the practice of thoracic epidural analgesia in the United Kingdom.
A postal survey of the practice of thoracic epidural analgesia was sent to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, with only 28% of respondents mentioning even the most common complications. Epidural cannulation is most often (60%) performed following induction of general anaesthesia, rather than in the awake patient. A test dose of local anaesthetic without adrenaline is usual. Neither aspirin nor low-dose heparin are considered a contraindication. The majority of respondents used a combination of bupivacaine with fentanyl (51%) or diamorphine (40%), usually administered by continuous infusion. Drugs were frequently prepared and adjusted by anaesthetic staff. The majority of epidurals (63%) are nursed in intensive care units postoperatively. Properly funded pain management teams, at present unusual, would facilitate ward-based epidural management and release intensive care resource. A central register of epidural complications is required to provide valuable evidence for the optimum practice of thoracic epidural analgesia.
Romer
H C
HC
Department of Anaesthesia, Cardiothoracic Centre-Liverpool NHS Trust, UK.
Russell
G N
GN
D015360:Analgesia, Epidural / Q000379:methods / Q000706:statistics & numerical data; D000761:Anesthesia Department, Hospital / Q000706:statistics & numerical data*; D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000075202:Contraindications; D005260:Female; D019538:Health Care Surveys; D006493:Heparin / Q000627:therapeutic use; D006779:Hospitals, Public; D006801:Humans; D007258:Informed Consent; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013222:State Medicine; D006113:United Kingdom
D000925:Anticoagulants; D006493:Heparin; D001241:Aspirin