[Results of a questionnaire survey of the practice and organization of postoperative peridural analgesia at 461 anesthesia departments].

Abstract

In 1988, questionnaires were sent to 1225 departments of anesthesiology to evaluate the practice of postoperative epidural analgesia (EA) in the Federal Republic of Germany. The following problems were investigated. To what extent are anesthesiologists concerned with postoperative pain therapy? Does EA play a major role in this, in particular outside the intensive care setting? Who is allowed to administer epidural injections: anesthesiologists, other physicians or nurses? What kind of monitoring is used? What agents are used for epidural injections and what problems and complications have arisen? In all, 461 (38%) evaluable forms were returned. Most anesthesiologists said they were responsible for postoperative pain control. In 75.3% of the responding departments EA was used as a method of postoperative pain therapy, while in 24.7% the catheter was removed immediately after the operation, in most cases for fear of complications resulting from insufficient monitoring. In clinical practice, however, EA was the only major alternative to routine intermittent injections of opioids as needed. Some departments reported that they restricted postoperative EA to patients in the intensive care unit or in the recovery room because adequate monitoring was not feasible on the ordinary wards. EA was administered in 62.4% on ordinary wards. But in only 25.7% were trained nurses allowed to give epidural injections. Most responding departments (77%) preferred epidural use of opioids during intensive care, in most cases morphine or buprenorphine in combination with low-dose local anesthetics, and 66.7% also favored epidural opioids on ordinary wards.