[Epidural analgesia apart from obstetrics: a survey of practice].
OBJECTIVE
To describe the current use of epidural anesthesia (EA) apart from obstetrics, and to explain the reasons of its low utilization.


METHODS
Observational study.


METHODS
A survey of practice with a self-questionnaire was sent by e-mail and available on Internet. Answers were compared between groups doing or not an epidural analgesia with exact Fisher tests (P<0.05 statistically significant).


RESULTS
Among the 176 anesthesiologists who answered to the questionnaire, only 21.4% never used epidural analgesia. The main reasons were alternatives therapeutics such as PCA with opioids or TAP block (24/38 vs. 46/140). TAP block was the most common alternative used by more than 50% of anesthesiologists. Loss of competence (4/30 vs. 0/39) was rarely the reason to its low utilization. The low accessibility to specialized postoperative units was recognized in both groups as a limiting factor to do an epidural but not the fear of neurological complications. Those who never perform epidural analgesia were statistically more often physicians between 40 and 50 years (12/38 vs. 19/140). Heparin, aspirin and clopidogrel are no longer contraindications according to anesthesiologists less than 40 years old (50/68 vs. 31/68; 44/68 vs. 31/68; 37/68 vs. 23/68 respectively) but not for older.


CONCLUSIONS
Epidural analgesia is performed more often by younger anesthesiologists. This survey suggests the need of specific postoperative area to allow anesthesiologist to perform and supervise safely this technique. Recommendations of the French society of Anesthesiologists are also poorly applied.
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France. Electronic address: remigagnoud@yahoo.com.
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Gagnoud
Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France; Inserm, UMR-S850, Limoges, France.
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JB
Woillard
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
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Ponsonnard
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France.
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J
Cros
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
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B
Youssef
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Faculté de médecine, 2, rue du Dr-Marcland, 87000 Limoges, France.
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Nathan
D000328:Adult; D000367:Age Factors; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000706:statistics & numerical data*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D001291:Attitude of Health Personnel; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011795:Surveys and Questionnaires
Acetylsalicylic acid; Analgésie péridurale; Aspirine; Clopidogrel; Complication; Enquête française; Epidural analgesia; Survey