The hidden cost of neuraxial anaesthesia?

Bedforth, N.; Hardman, Jonathan G.

doi:10.1111/j.1365-2044.2010.06364.x

Cited by 8 publications

(4 citation statements)

References 7 publications

(6 reference statements)

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“…A closed-claim analysis of medicolegal cases related to regional anaesthesia in the United Kingdom showed that the costs of claims associated with epidural techniques were far higher than those associated with peripheral nerve blocks. 48 A survey of Australian anaesthesiologists showed that 82% had changed their practice in recent years in that they performed fewer epidural anaesthetics. The 2 most common reasons were fear of litigation and a lack of evidence for beneficial effects.…”

Section: Risks Of Epidural Techniquesmentioning

confidence: 99%

Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

231

136

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Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.

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Section: Risks Of Epidural Techniquesmentioning

confidence: 99%

Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

231

136

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“…Significant risks related to epidural analgesia are dural puncture, epidural haematoma, abscess, and spinal cord injury [28, 40]. A close‐claim analysis of medicolegal cases related to regional anaesthesia in the UK showed that the claim costs associated with epidural analgesia are far higher than those associated with peripheral analgesia [2], making it less attractive for general use [36]. Furthermore, although no serious complications occurred in the FCCEB group because we used fluoroscopic guidance, UCISB is thought to be safer and more effective than FCCEB for analgesia following ARCR because of lower risk of complications and greater analgesic potency.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair

Kim

Song

Kim

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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“…Obstetric anesthesia is a high risk specialty [12][13][14][15]. It is not necessary to be negligent during a procedure such as spinal anesthesia for damage to occur [15].…”

Section: Discussionmentioning

confidence: 99%

A Study of the Quality of Informed Consent of Anesthesia for Cesarean Deliveries: What and Whatnot was Discussed with Parturients

Ajmal¹

2014

J Anesth Clin Res

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Study objective:To examine whether the principle of informed consent was applied to practice of anesthesia for elective cesarean deliveries in our general hospital.Design: Prospective observational cohort study.Setting: Maternity ward of a general hospital. Study subjects:Twenty-five parturients in their postoperative period after their first and elective cesarean deliveries and 25 anesthesiologists.Interventions: Application of a questionnaire and an information pamphlet describing various forms of anesthesia for cesarean delivery. Measurements/Observations:To assess patients' background knowledge about anesthesia, to determine the quality of informed-consent applied to the practice of anesthesia for elective cesarean deliveries i.e. explanation of proposed anesthesia procedure to parturients undergoing cesareans including explanation of advantages, disadvantages of proposed anesthesia procedure, alternative to proposed anesthesia procedure, explanation of its relative advantages and disadvantages and influence of adequate disclosure on patients' choice of anesthesia. Results:In 19/25 parturients, trainees and in 6/25, consultants administered informed consent of anesthesia. All study patients (25/25) received spinal anesthesia. All those patients were given some information about spinal anesthesia but none of the patients (0/25) was informed about the availability of epidural or general anesthesia for their cesarean deliveries and benefits and risks associated with these techniques. Conclusion:In this single institution study, patients reported that the risks/benefits of all possible anesthetic options for an elective cesarean delivery were not addressed during the informed consent process.

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The hidden cost of neuraxial anaesthesia?

Cited by 8 publications

References 7 publications

Epidural Technique for Postoperative Pain

Epidural Technique for Postoperative Pain

Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair

A Study of the Quality of Informed Consent of Anesthesia for Cesarean Deliveries: What and Whatnot was Discussed with Parturients

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