ANALGESIA FOLLOWING THORACOTOMY - A SURVEY OF AUSTRALIAN PRACTICE

This survey examines pain management after thoracotomy in Australian h ospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in th e analyses. Seventy-two percent of respondents were from hospitals wit h acute pain services (APS), and in 94% of these hospitals patients ar e reportedly visited by the APS. The most frequently used analgesic mo dalities are epidural analgesia, intravenous patient-controlled analge sia (IVPCA), and nurse-controlled intravenous opioid infusions. Over h alf of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or parace tamol. Combinations of analgesic techniques were cited frequently Resp ondents reported that cryoanalgesia, interpleural blockade, paraverteb ral blockade, subarachnoid infusions, ketamine, and transcutaneous ele ctrical nerve stimulation are used infrequently. Anaesthetists from pu blic hospitals reported using epidural analgesia, IVPCA and NSAIDs mor e frequently than those from private hospitals. When epidural analgesi a is used most respondents place the catheter in the mid-thoracic regi on (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for rip to three days (83%). Over half of the respondents reported that post-tho racotomy patients are nursed in a high-dependency area. Seventy-nine p ercent of respondents selected epidural analgesia as the best availabl e analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently.