A SURVEY OF THE PRACTICE OF THORACIC EPIDURAL ANALGESIA IN THE UNITED-KINGDOM

A postal survey of the practice of thoracic epidural analgesia was sen t to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, wit h only 28% of respondents mentioning even the most common complication s. Epidural cannulation is most often (60%) performed following induct ion of general anaesthesia, rather than in the awake patient. A test d ose of local anaesthetic without adrenaline is usual. Neither aspirin nor low-dose heparin are considered a contraindication. The majority o f respondents used a combination of bupivacaine with fentanyl (51%) or diamorphine (40%), usually administered by continuous infusion. Drugs were frequently prepared and adjusted by anaesthetic staff. The major ity of epidurals (63%) are nursed in intensive care units postoperativ ely. Properly funded pain management teams, at present unusual, would facilitate ward-based epidural management and release intensive care r esource. A central register of epidural complications is required to p rovide valuable evidence for the optimum practice of thoracic epidural analgesia.