The changing practice of thoracic epidural analgesia in the United Kingdom: 1997-2004.
The clinical governance framework and medico-legal climate in the United Kingdom has changed significantly in the past 7 years. We used a postal questionnaire to survey thoracic epidural practice in the United Kingdom in 1997 and repeated this survey in 2004. The response rate to both surveys was 59-60%. There has been considerable change in respect of taking specific consent for thoracic epidural analgesia (24% in 1997, 74% in 2004), awake epidural cannulation (40% in 1997, 84% in 2004), availability of an acute pain service (47% in 1997, 95% in 2004) and HDU-only nursing of patients (63% in 1997, 30% in 2004). Of the 2004 respondents, < 1% used the newer, less toxic local anaesthetics, 49% would consider inserting a thoracic epidural in patients receiving clopidogrel, and 34% would consider inserting a thoracic epidural in patients receiving both aspirin and clopidogrel. A central register of thoracic epidural complications would assist in further developing practice.
Consultant, Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE. stephen.pennefather@ctc.nhs.uk
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Pennefather
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Gilby
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Danecki
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Russell
D015360:Analgesia, Epidural / Q000941:ethics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D000779:Anesthetics, Local / Q000008:administration & dosage; D004334:Drug Administration Schedule; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent; D008991:Monitoring, Physiologic / Q000379:methods / Q000639:trends; D010149:Postoperative Pain / Q000628:therapy*; D011364:Professional Practice / Q000706:statistics & numerical data / Q000639:trends*; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000779:Anesthetics, Local