We appreciate the effort of Drewel-Frohnmeyer et al in highlighting the common but very important post-epidural problems. A similar audit which we undertook in 2005-2006 over a period of 9 months, involved 235 patients undergoing major abdominal surgery had demonstrated similar results to the published audit. All the patients had thoracic epidural catheters inserted for major abdominal surgery but at various levels ranging from T4 to T11 according to individual anaesthetists preference and practice. The catheter insertion depth again was not standardized and ranged from 4 to 7 cm from the skin. All the anaesthetists had more or less similar method of fixing, with forming one loop of catheter and fixing the catheter with 3M™ Tegaderm™ film.

After initial 15-20 ml of 0.25 - 0.375% plain bupivacaine, postoperative analgesia was achieved by continuous infusion of 0.125% bupivacaine with 2 µg.ml of fentanyl. 47% (n=101) of patients had epidural-related complications postoperatively (catheter related, drug related and t echnique related). Epidural catheter was dislodged in 4 % (n= 10) of patients, and as the authors emphasised, the depth of catheter insertion played a major part in this complication (the rate of dislodgment was more with catheters inserted less than 5 cm from the skin). The other catheter-related complication we noted were disconnection, kinking, and leakage (5%, n=11). The incidence of motor block was low in our audit (3%, n=8), as all our epidurals are performed at the thoracic and this reduced the number of patients with motor block postoperatively. This again correlates with the authors finding o fdecreasing motor block with more thoracic placement of catheters.

In our audit there were no major complications such epidural haematoma, abscess or neurological damage.