Provision of postoperative epidural services in NHS hospitals

To describe facilities for postoperative epidurals in UK National Health Service Hospitals, a questionnaire was sent to each hospital performing surgery below the head and neck. Of 271 hospitals, 256 replied (95%). While almost all offer postoperative epidurals, only 78 (30%) offer them to all surgical disciplines. Most hospitals rely on acute pain nurses for troubleshooting during the day, and on trainee anaesthetists after hours. Administration is most commonly by continuous infusion. There was no restriction on the use of epidural opioids in 67% of hospitals. Most (96%) hospitals have a protocol for epidural care, although the specified level of monitoring varies widely. There is no consensus of practice on removal of epidural catheters relative to anticoagulation. Levels of training in epidural care also vary widely. Two hundred and thirty-six hospitals (92%) have an acute pain team. Despite the expansion in acute pain services, facilities for postoperative epidurals are deficient in many NHS hospitals.