Epidural analgesia following upper abdominal surgery: United Kingdom practice

• Published in: Acta anaesthesiologica Scandinavica Vol. 41; no. 1; pp. 18 - 24
• Main Authors: COOK, T. M., EATON, J. M., GOODWIN, A. P. L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.1997; Blackwell
• Subjects: Abdomen - surgery; Abdominal surgery. Urology. Gynecology. Obstetrics; Analgesia; Analgesia, Epidural - statistics & numerical data; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - therapeutic use; Biological and medical sciences; epidural; Humans; laparotomy; Medical sciences; opioid; Pain, Postoperative - drug therapy; Surveys and Questionnaires; United Kingdom; United Kingdom; Europe; Postoperative; Analgesia; Survey; Regional anesthesia; Pain; Treatment; Surgery; Professional practice; Extradural administration; Abdomen
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.1997.tb04608.x

Background: Epidural Analgesia (EA) may be used to provide pain relief after upper abdominal surgery. A variety of drugs and combinations may be used. Potential side effects lead some to believe EA should be restricted to high care areas. Method: The use of EA following upper abdominal surgery is surveyed in 214 hospitals in the United Kingdom by means of a postal questionnaire. Results: Sixty‐seven percent use EA frequently 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 most frequently achieved using a mixture of an opioid and a local anaesthetic (97%). No other agents are used. Fentanyl and diamorphine are the 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 after administering heparin. Use of EA is restricted solely to intensive or high‐care units in 46% of hospitals. In 82% of departments, EA is continued for up to 72 h. Ninety‐six percent of departments use continuous 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. Conclusion: EA is widely used in the United Kingdom following upper abdominal surgery. A degree of consensus exists on the choice of drug types, their method of administration and duration. There is no consensus as to whether the technique should be used on a general ward, which opioid should be used or the timing of heparin.