A national survey of epidural use and management in elderly patients undergoing elective and emergency laparotomy

Abstract

SummaryA postal questionnaire was sent to anaesthetic clinical tutors in the United Kingdom describing two hypothetical 75-year-old patients requiring abdominal surgery. Patient 1 (ASA 2) required elective anterior resection and patient 2 (ASA 3-4) required emergency laparotomy. There was a 65% response rate. For patient 1, 98.5% of respondents would insert an epidural, 93% inserting this awake and 50% placing it in the high-mid thoracic region. All respondents would use local anaesthesia (concentration varied four-fold) and 62% would use opioids. All respondents would place the epidural pre-operatively; although 36% would administer the epidural block preoperatively and 3% postoperatively. For patient 2, 70% of respondents would insert an epidural (p < 0.0001), drug administration would be more frequently delayed until postoperatively (13%); p = 0.0005) and epidural opioid use decreased (57%); p = n ⁄ s. Epidural insertion influenced the postoperative destination in 42% of departments. Use of a critical care facility was anticipated for more than half of these patients; 60% reported difficulty accessing critical care beds.

Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients

“…Epidural analgesia continues to remains the gold standard after elective open surgery in many centres in the UK [12]. There is a trend to move away from epidural analgesia when it comes to laparoscopic surgery as well as emergency laparotomy in patients with features of systemic inflammatory response syndrome [10][11][12][13][14]. The principal reason may be the high-risk benefit profile associated with the technique.…”

“…The last decade has seen the advent of new techniques for providing analgesia after both open and laparoscopic abdominal surgery [1][2][3][4][5][9][10][11]. Epidural analgesia continues to remains the gold standard after elective open surgery in many centres in the UK [12]. There is a trend to move away from epidural analgesia when it comes to laparoscopic surgery as well as emergency laparotomy in patients with features of systemic inflammatory response syndrome [10][11][12][13][14].…”

A national survey of management of patients aged over 75 years undergoing elective and emergency laparotomy

“…We have reported and discussed the epidural results separately [8]. We pass no further comment, other than to highlight the fact that although there is apparent scientific equipoise in the medical literature over the use of epidurals for major surgery [16,17], this survey suggests that epidural insertion is almost uniform practice in the UK.…”

“…We have reported the data on the use of epidurals and their management from this survey in greater detail separately [8]. Briefly, the planned use of epidurals was almost universal in patient A (99%) and frequent for patient B (71%) (p B0.0001).…”

Cancer du poumon en oncogériatrie : quelles possibilités chirurgicales dans le grand âge ?

“…Grâce à une meilleure compréhension de la pharmacocinétique propre aux personnes âgées, les produits anesthésiques sont maintenant à la fois plus efficaces et plus sûrs [40][41][42][43]. La douleur postopératoire est gérée avec une analgésie épidurale utilisant des anesthésiques locaux et/ou des opiacés, significativement plus efficaces que les opioïdes par voie parentérale chez ces patients [42,44]. La diminution physiologique des réserves fonctionnelles de l'individu avec l'âge est à prendre en compte lors d'une anesthésie générale.…”