EPIDURAL ANALGESIA FOLLOWING UPPER ABDOMINAL-SURGERY - UNITED-KINGDOMPRACTICE

Background: Epidural Analgesia (EA) may be used to provide pain relief after upper abdominal surgery. A variety of drugs and combinations ma y be used. Potential side effects lead some to believe EA should be re stricted to high care areas. Method: The use of EA following upper abd ominal surgery is surveyed in 214 hospitals in the United Kingdom by m eans of a postal questionnaire. Results: Sixty-seven percent use EA fr equently 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 m ost frequently achieved using a mixture pf an opioid and a local anaes thetic (97%). No other agents are used. Fentanyl and diamorphine are t he 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 aft er administering heparin. Use of EA is restricted solely to intensive or high-care units in 46% of hospitals. In 82% of departments, EA is c ontinued for up to 72 h. Ninety-six percent of departments use continu ous epidural infusions in the postoperative 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. Conclu sion: EA is widely used in the United Kingdom following upper abdomina l surgery. A degree of consensus exists on the choice of drug types, t heir method of administration and duration. There is no consensus as t o whether the technique should be used on a general ward, which opioid should be used or the timing of heparin.