O'Higgins F, Tuckey J P
Department of Anaesthesia, Royal United Hospital, Bath, UK.
Acta Anaesthesiol Scand. 2000 Oct;44(9):1087-92. doi: 10.1034/j.1399-6576.2000.440909.x.
Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists.
A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom.
Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-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 (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia.
In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up.
近年来，胸段硬膜外镇痛的应用越来越广泛。并发症虽罕见但可能很严重，因此在采用该技术前需要仔细评估。麻醉医生在这一操作上的做法差异很大。
向英国皇家麻醉师学院的所有导师发送了一份关于胸段硬膜外镇痛应用情况的邮政调查问卷。
收到了240名导师的回复，回复率为83%。在获取胸段硬膜外置管的知情同意时，42%的受访者提到了硬膜穿破并发症的风险，11%的受访者提到了神经损伤。50%的受访者在全身麻醉诱导后进行硬膜外置管。对于凝血异常患者的硬膜外置管做法各不相同，不过超过80%的受访者不认为同时使用阿司匹林或非甾体类抗炎药是禁忌证。麻醉医生在硬膜外置管时的无菌预防措施也各不相同。术后，95%的受访者使用基于阿片类药物的布比卡因溶液进行硬膜外输注，这些患者最常安置在普通外科病房（63%）。78%的医院设有急性疼痛治疗小组来评估硬膜外镇痛情况。
在英国，对于胸段硬膜外镇痛在知情同意、凝血功能紊乱患者的硬膜外置管以及硬膜外置管前采取的无菌预防措施等问题上，做法几乎没有共识。大多数受访者使用基于阿片类药物的布比卡因溶液提供术后硬膜外镇痛。英国现在大多数医院都提供胸段硬膜外随访的急性疼痛服务。
