alexa Techniques for identifying the epidural space: a survey of practice amongst anaesthetists in the UK.


Journal of Anesthesia & Clinical Research

Author(s): Wantman A, Hancox N, Howell PR

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Abstract A postal survey of all UK members of the Obstetric Anaesthetists' Association was carried out to ascertain their preferred method for identifying the epidural space in obstetric and non-obstetric patients. Over 1200 questionnaires were returned (79.3\% response rate). In obstetric patients, the single most common technique (used by 58\% of anaesthetists) was continuous advancement of the epidural needle and loss of resistance with saline, followed by intermittent needle advancement with air (21\%). A minority of respondents used other variants, including intermittent advancement with saline (16\%) and continuous advancement with air (4\%). Consultant anaesthetists showed greater variety in techniques used than did trainees (p < 0.001). Less than 5\% of respondents used a paramedian approach, and these were almost exclusively senior staff. Only 48\% of anaesthetists said they would try an alternative if they experienced difficulty with their preferred technique. A similar pattern was seen for lumbar epidurals in non-obstetric surgical patients (89\% used the same technique as in obstetrics), although for thoracic epidurals, 23\% used a different technique to that which they would use for obstetrics, and the paramedian approach was more popular (21\%). When inserting lumbar epidurals to supplement general anaesthesia in surgical patients, 18\% of anaesthetists said they usually performed the block with the patient asleep, whereas for thoracic epidurals, this figure fell to 14\%. This article was published in Anaesthesia and referenced in Journal of Anesthesia & Clinical Research

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