'high-risk', it was expected to show significant outcome benefits.We recently examined pain service audit and clinical coding data in a New Zealand Tertiary Hospital for the 3 years before and after the MASTER study [3]. We excluded obstetric epidurals from our dataset. We found a 43% stepwise drop in overall epidural numbers and a 59% drop in epidurals associated with colonic surgery, in the years following the MASTER publication, compared with the years preceding. There appeared to be a clear temporal relationship between the publication and the change in practice, and in our paper we suggest that publication of the MASTER trial has acted as a 'tipping point' where, in the minds of anaesthetists, the overall weight of evidence was against routine epidural usage.We also surveyed anaesthetists in the study hospital who were working throughout our 6-year review period. We found 75% had indeed changed their practice as a result of this trial with all of these respondents reporting a decrease in their usage of epidurals. Other reasons cited for change reflect the issues raised in the editorial, such as difficulty with fluid management and maintenance of vasopressor regimens on standard wards. Our findings concur with data from Queensland, Australia where a survey showed 82% of specialists were using more patient-controlled analgesia techniques over epidural analgesia [4].We are sure that this editorial will generate vigorous defence of epidurals and that the flaws of the MASTER study will be well illuminated. Our most recent local data, which we are collating for publication, would suggest that the debate may be sterile however, as we have seen a continued decline in epidural usage, beyond the dramatic fall seen around the time of the MASTER study. Instead intrathecal opioids as part of a multimodal pain strategy appear to be ascendant.
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