EPIDURAL AND INTRATHECAL OPIOIDS FOR POSTOPERATIVE PAIN MANAGEMENT INEUROPE - A 17-NATION QUESTIONNAIRE STUDY OF SELECTED HOSPITALS

Background: A questionnaire study conducted with the help of selected contact persons in 17 countries in Europe attempted to create a pictur e of the practice of acute pain management with the use of spinal opio id analgesia (SOA). Methods: A questionnaire was mailed to anaesthesio logists in 105 European hospitals. Depending on the population, 5-10 h ospitals from each country were selected by a country co-ordinator. Re sults: A total of 101 (96.2%) completed questionnaires were returned. During 1 year SOA was used in 55,117 patients (6.6% of all in-patient surgical procedures); of these, 89.2% received epidural opioids and 10 .8% intrathecal opioids (ratio 8:1). The most common opioid for SOA wa s morphine; fentanyl was also used quite frequently; 12 different opio ids and 8 non-opioids had been used. ASA 1-2 patients receiving epidur al morphine were nursed on surgical wards in 58.4% of the hospitals; i n 25.7% of hospitals even ASA 3-4 were nursed on surgical wards. Respi ratory depression (requiring naloxone treatment) was noted in 45 of th e 49,183 patients who received epidural opioids (0.09%); 33 of these p atients had received morphine. In more than 75% of hospitals the monit oring variables were respiratory rate, sedation level and pulse oximet ry. There was a great difference between hospitals and countries regar ding duration of monitoring. Conclusions: This questionnaire study sho wed that SOA was used in about 7% of 836,000 in-patients undergoing su rgery at the 105 selected hospitals. Epidural opioids were used eight times more often than intrathecal opioids. Morphine was the commonest opioid for SOA. The duration of monitoring differed greatly between ho spitals and countries; the need for official guidelines is emphasized.