A survey of neuraxial analgesic preferences in open and laparoscopic major abdominal surgery amongst anaesthetists in Australia and New Zealand

Abstract

Practising anaesthetists who are Fellows of the Australian and New Zealand College of Anaesthetists were surveyed with the objective of gaining insight into current analgesic preferences, with particular regard to neuraxial techniques, when managing patients having major open and laparoscopic abdominal surgery. Major abdominal surgery is common and effective analgesia is fundamental to optimal postoperative recovery. A multitude of analgesic options exist, with epidurals recommended in recent Enhanced Recovery After Surgery protocols. We believe the place of epidurals is increasingly questioned in the setting of continuous improvement in surgical technique, with increasing laparoscopic and robotic-assisted surgery. Evidence for various techniques is mixed and benefit-risk profiles exist for all alternatives. An opioid epidemic and abuse crisis has directed attention towards opioid minimisation strategies. The survey was completed by 28% (275) of the 975 Fellows who received it, with good representation across the Australian and New Zealand College of Anaesthetists' general membership. Respondents manage laparoscopic major abdominal surgery more frequently than open procedures, with approximately one-third of respondents each providing anaesthesia for two open laparotomies versus four to eight laparoscopic cases per month. Respondents reported a high perceived benefit of neuraxial analgesia, which was discordant with their clinical practice. Less than half of the respondents used epidural or spinal analgesia in open surgery (48% versus 49% of respondents, respectively). A minority (16%) of respondents use a neuraxial technique in major laparoscopic surgery, with a strong preference for intrathecal morphine (74%) when they choose to do so. Further investigation of the role of intrathecal analgesia is warranted given the shift towards laparoscopic major abdominal surgery, the perceived benefits of neuraxial techniques and the need for opioid-sparing analgesic strategies.