Epidural analgesia following upper abdominal surgery: United Kingdom practice.

Abstract:

BACKGROUND:Epidural Analgesia (EA) may be used to provide pain relief after upper abdominal surgery. A variety of drugs and combinations may be used. Potential side effects lead some to believe EA should be restricted to high care areas. METHOD:The use of EA following upper abdominal surgery is surveyed in 214 hospitals in the United Kingdom by means of a postal questionnaire. RESULTS:Sixty-seven percent use EA frequently and 3% not at all. The low thoracic site is the most commonly used, by 65%. Forty-eight percent use a combination of sites. EA is most frequently achieved using a mixture of an opioid and a local anaesthetic (97%). No other agents are used. Fentanyl and diamorphine are the opioids used most widely (61% and 52% departments, respectively) in combination with local anaesthetic. Subcutaneous heparin is regularly used in 89% of departments. In 43%, the epidural is sited shortly after administering heparin. Use of EA is restricted solely to intensive or high-care units in 46% of hospitals. In 82% of departments, EA is continued for up to 72 h. Ninety-six percent of departments use continuous epidural infusions in the post-operative period. Adjunct analgesia includes non-steroidal anti-inflammatory drugs in 50% of departments. An anaesthetist supervises EA in 89% of hospitals. EA is considered to be the best mode of analgesia available by 80% of respondents. CONCLUSION:EA is widely used in the United Kingdom following upper abdominal surgery. A degree of consensus exists on the choice of drug types, their method of administration and duration. There is no consensus as to whether the technique should be used on a general ward, which opioid should be used or the timing of heparin.

authors

Cook TM,Eaton JM,Goodwin AP

doi

10.1111/j.1399-6576.1997.tb04608.x

subject

Has Abstract

pub_date

1997-01-01 00:00:00

pages

18-24

issue

1 Pt 1

eissn

0001-5172

issn

1399-6576

journal_volume

41

pub_type

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