Thoracic epidural anaesthesia and analgesia: United Kingdom practice

Background: Thoracic Epidural, analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, conseq uently, careful evaluation is required before undertaking this technique. T he practice surrounding this procedure varies widely amongst anaesthetists. Methods: A postal survey to examine the practice of thoracic epidural analg esia was sent to all Royal College of Anaesthetists tutors in the United Ki ngdom. Results: Responses were received from 240 tutors, representing a return rat e of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned ne urological damage. Fifty percent of respondents performed epidural cannulat ion following induction of general anaesthesia. The practice of epidural in sertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or no n-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (6 3%). Seventy-eight percent of hospitals provided an acute pain team to revi ew epidural analgesia. Conclusion: In the United Kingdom, there is little consensus in the practic e of thoracic epidural analgesia relating to the issues of informed consent , epidural cannulation in patients with deranged clotting and the sterile p recautions taken prior to performing epidural insertion. Most respondents u se an opioid-based bupivacaine solution to provide postoperative epidural a nalgesia. Most hospitals in the UK now provide an acute pain service for th oracic epidural follow-up.