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The changing practice of thoracic epidural analgesia in the United Kingdom: 1997-2004.

Pennefather SH, Gilby S, Danecki A, Russell GN

Consultant, Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE. stephen.pennefather@ctc.nhs.uk

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.

Published 21 March 2006 in Anaesthesia, 61(4): 363-9.
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