This national audit concerning use and safety of epidural analgesia demonstrates that a minority of Dutch hospitals have procedures to manage suspected neurological complications of epidural analgesia, whereas in the remaining hospitals responsibilities and timelines for management of epidural emergencies are determined on an ad hoc basis.
The clinical use of epidural analgesia has changed over past decades. Minimally invasive surgery and emergence of alternative analgesic techniques have led to a decline in its use. Additionally, there is increasing awareness of the patient-specific risks for complications such as spinal haematoma and abscess. Local guidelines for management of these severe neurological complications during or after epidural analgesia, i.e. 'epidural alert systems', have been introduced in some hospitals to coordinate and potentially streamline early diagnosis and treatment. How widely such protocols have been implemented in daily practice is unknown.We conducted a web-based survey in order to analyse trends in practice, key safety measures, reporting and management of complications of epidural analgesia in the Netherlands. In January 2016 a questionnaire was sent to all hospitals in the Netherlands. Last questionnaires were collected in August 2016. Children's hospitals, private practices and outpatient clinics were excluded. For each location one anaesthesiologist (typically the head of service or clinical lead for regional anaesthesia services) was asked to fill in the questionnaire or identify the most appropriate anaesthesiologist to answer the questionnaire based on clinical involvement in neuraxial anaesthesia. We used descriptive statistics to analyse data.
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