Adherence to Practice Guidelines for Postoperative Epidural Analgesia.

Objective: To evaluate the adherence to practice guidelines for epidural insertion along with the medicines used for postoperative analgesia and the incidence of complications.

Study design: Clinical audit. Place and Duration of the Study: Doctors Hospital and Medical Centre, Lahore, Pakistan, from January 2021 to December 2023.

Methodology: Non-probability consecutive sampling technique was used to collect the data. After the approval to conduct this audit was obtained from the Ethical Committee of the hospital, data were collected from Surgical Epidural Registers of the anaesthesia department. All calculations were done manually and then put in Microsoft Word Document.

Results: A total of 308 surgical epidurals were inserted over the period of three years. Procedures constituted 125 (40.6%) orthopaedic procedures, 41 (13.31%) thoracic surgery procedures, 36 (11.7%) general surgery procedures, 25 (8.11%) hepatobiliary procedures, 14 (4.54%) urology procedures, and 12 (3.89%) gynaecological procedures. Level of insertion was as per the recommended guidelines in 200 (64.9%) patients out of 308. Bupivacaine was the most commonly used medicine, with 0.1% concentration generally preferred in the authors' setup. Among the adjuvants, fentanyl, dexmedetomidine, and tramadol were used. Overall complication rate was 40 (12.98%), with motor blockade being the most common, followed by nausea/vomiting, hypotension, dural tap, and blood tap.

Conclusion: This audit will help in rectifying the loopholes in the surgical epidural analgesia services provided by the authors' study centre, but also other epidural analgesia service providers to make changes in their practices for better outcomes in future.

Key words: Epidural analgesia, Dural tap, Blood tap, Motor blockade, Bupivacaine.