Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists

• Published in: Pediatric anesthesia Vol. 13; no. 9; pp. 769 - 776
• Main Authors: Williams, D.G., Howard, R.F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-11-2003; Blackwell
• Subjects: analgesia; Analgesia, Epidural - adverse effects; Analgesia, Epidural - standards; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - standards; Anesthesiology - statistics & numerical data; Attitude of Health Personnel; Biological and medical sciences; Child, Preschool; children; epidural; Health Care Surveys; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Infant, Newborn; Local anesthesia. Pain (treatment); Medical Audit - utilization; Medical sciences; Monitoring, Physiologic; Pediatrics - standards; Pediatrics - statistics & numerical data; postal survey; Practice Patterns, Physicians' - standards; Surveys and Questionnaires; United Kingdom; United Kingdom; Europe; Human; Attitude; Health staff; Analgesia; Pain; Treatment; children; Professional practice; Extradural administration; Anesthesiologist; postal survey; epidural; Child
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1046/j.1460-9592.2003.01211.x

Summary
Background Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed.
Methods Questionnaires were sent to the members of the Association of Paediatric Anaesthetists (APA) working within the UK and to lead clinicians and clinical nurse specialists for acute pain in the 26 designated major paediatric centres.
Results The response rate was 72%. There was little consensus regarding drugs and drug combinations used for epidural analgesia. A total of 36% of paediatric centres did not audit their epidural practice, and of those that did the reported incidences of side‐effects showed wide variation. Important differences in practice were also identified in the areas of patient selection, informed consent, the use of epidural test doses, drug delivery systems, monitoring and the management of side‐effects. Twelve per cent of specialist paediatric hospitals did not have an acute pain team and elsewhere the provision was often limited to staff with few or no specialist skills.
Conclusion There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.