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CANADIAN SURVEY OF THE USE OF EPIDURAL ANESTHESIA AND ANALGESIA

Departments of Anesthesia University of Toronto and McMaster University

INTRODUCTION

Epidural blockade provides superior analgesia, reduces postoperative respiratory complications, and improves quality of life postoperatively. Two meta-analysis have suggested that thoracic epidural decrease postoperative myocardial infarction and death. This survey was conducted to assess the frequency of epidural usage, and determine the placement of catheters and whether a randomized trial was possible in Canada

METHODS

A survey, containing, nine questions were mailed the chair of each university department of anesthesia for distribution to their respective clinical sites. We sought information on the size of the hospital, number of operative procedures, the number of epidurals performed in the last year, the presence or absence of an acute pain service and the units on which epidurals were permitted. For each type of surgery performed, we asked whether or not epidurals were offered, and the anatomic level at which catheters were placed. The data is as medians and percentages.

RESULTS

We received response from 13 of the 16 departments of anesthesia (82%)and 34 of 64 hospitals (53%) These hospitals have a median of 400 beds, performing 13,500 procedures per year. Thirty hospitals (88%) have an active acute pain service. In total, 21000 epidurals were performed last year. A median of 500 epidurals were performed in each hospital last year.

CONCLUSION

There is variable utilization of epidural anesthesia and analgesia across Canada. When used, epidural catheters are inserted predominately at the thoracic level. 20% of centers do not offer epidural analgesia for vascular surgery. Academic centers would be willing to randomize 50% of patients to a trial of epidural analgesia.

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