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The changing practice of thoracic epidural analgesia in the United Kingdom: 1997–2004
Author(s) -
Pennefather S. H.,
Gilby S.,
Danecki A.,
Russell G. N.
Publication year - 2006
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2006.04549.x
Subject(s) - medicine , cardiothoracic surgery , clopidogrel , anesthesia , local anaesthetic , aspirin , surgery
Summary The clinical governance framework and medico‐legal climate in the United Kingdom has changed significantly in the past 7 years. We used a postal questionnaire to survey thoracic epidural practice in the United Kingdom in 1997 and repeated this survey in 2004. The response rate to both surveys was 59–60%. There has been considerable change in respect of taking specific consent for thoracic epidural analgesia (24% in 1997, 74% in 2004), awake epidural cannulation (40% in 1997, 84% in 2004), availability of an acute pain service (47% in 1997, 95% in 2004) and HDU‐only nursing of patients (63% in 1997, 30% in 2004). Of the 2004 respondents, < 1% used the newer, less toxic local anaesthetics, 49% would consider inserting a thoracic epidural in patients receiving clopidogrel, and 34% would consider inserting a thoracic epidural in patients receiving both aspirin and clopidogrel. A central register of thoracic epidural complications would assist in further developing practice.