Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures

Six hundred and Forty patients received epidural analgesia for postoperativ e pain relief following major surgery in the 6-year period 1993-1998. Altho ugh satisfactory pain relief was achieved in over two-thirds of patients fo r a median duration of 44 h after surgery, one-fifth of patients (133 indiv iduals) still experienced poor pain relief. Almost one out of three patient s (194 individuals) had a problem with their epidural. Eighty-three patient s (13%) suffered a technical failure and 84 (13%) patients had their epidur als removed at night time when pain-free because of pressure on beds. Seven patients had their epidural replaced and subsequently experienced excellen t pain relief for a median of 77 h. Lack of resources prevented a further 4 80 patients from receiving the potential benefits of epidural analgesia. Th ese results would suggest that the practical problems of delivering an epid ural service far outweigh any differences in drug regimens or modes of deli very of epidural solutions.