Romer H C, Russell G N
Department of Anaesthesia, Cardiothoracic Centre-Liverpool NHS Trust, UK.
Anaesthesia. 1998 Oct;53(10):1016-22. doi: 10.1046/j.1365-2044.1998.00525.x.
A postal survey of the practice of thoracic epidural analgesia was sent to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, with only 28% of respondents mentioning even the most common complications. Epidural cannulation is most often (60%) performed following induction of general anaesthesia, rather than in the awake patient. A test dose of local anaesthetic without adrenaline is usual. Neither aspirin nor low-dose heparin are considered a contraindication. The majority of respondents used a combination of bupivacaine with fentanyl (51%) or diamorphine (40%), usually administered by continuous infusion. Drugs were frequently prepared and adjusted by anaesthetic staff. The majority of epidurals (63%) are nursed in intensive care units postoperatively. Properly funded pain management teams, at present unusual, would facilitate ward-based epidural management and release intensive care resource. A central register of epidural complications is required to provide valuable evidence for the optimum practice of thoracic epidural analgesia.
一项关于胸段硬膜外镇痛实践的邮政调查被发送至英国的275家医院。70%的医院进行了回复。知情同意很少能得到充分获取，只有28%的受访者提及哪怕是最常见的并发症。硬膜外置管最常（60%）在全身麻醉诱导后进行，而非在清醒患者中进行。通常使用不含肾上腺素的局部麻醉药试验剂量。阿司匹林和低剂量肝素均不被视为禁忌证。大多数受访者使用布比卡因与芬太尼（51%）或二氢吗啡酮（40%）的组合，通常通过持续输注给药。药物常由麻醉人员配制和调整。大多数硬膜外镇痛患者（63%）术后在重症监护病房护理。目前并不常见的资金充足的疼痛管理团队将有助于在病房进行硬膜外管理并释放重症监护资源。需要建立硬膜外并发症中央登记册，为胸段硬膜外镇痛的最佳实践提供有价值的证据。
