The Use of Epidural Analgesia in a New Zealand Tertiary Hospital before and after Publication of the Master Study

Abstract

We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P<0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.

Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial

“…Although, most adverse morbid outcomes in high-risk patients undergoing major abdominal surgery are not reduced by use of a combined epidural and general anesthesia technique, the improvement in analgesia and reduction in respiratory failure and the low risk of serious adverse events makes it likely that high-risk patients undergoing major intra-abdominal surgery will benefit from this combination technique [ 26 , 27 ]. Nevertheless, after the publication of the MASTER study, the use of this combination of techniques has declined in some parts of the world [ 28 ].…”

Perioperative care: a survey of New Zealand and Australian colorectal surgeons

“…The use of an epidural has not been shown to significantly affect the length of hospital stay but does produce better postoperative pain control, a decrease in paralytic ileus, a decrease in respiratory complications, and metabolic benefits, when compared with parenteral opioids after colorectal surgery [19–21]. The use of epidural analgesia may have fallen out of favour after publication of the MASTER trial results [22]. TAP blockade has shown potential for analgesia alone but there have been no studies comparing this route directly with epidural analgesia after abdominal surgery [23,24].…”

Epidural analgesia: first do no harm

“…We recently examined pain service audit and clinical coding data in a New Zealand Tertiary Hospital for the 3 years before and after the MASTER study [3]. We excluded obstetric epidurals from our dataset.…”