Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Introduction Our objective was to examine departmental practices regarding perioperative epidural placement in the Mater Hospital over a 4-year period.

Methods Methods Our anaesthesia information management database was queried to retrieve details of perioperative epidural placement from 2017 to 2020. Data captured included patient position, loss of resistance (LOR) technique, complications and documentation quality.

Results Results 1072 epidurals were placed in the study period. Epidural use declined from 309 in 2017 to 210 in 2020. There was a large decrease in epidural placement for Thoracic and Urology surgery while epidurals for Gynaecological surgery increased. In the same period there was also a large decline in abdominal blocks and an increase in thoracic blocks performed. The large majority of epidurals were sited in the sitting position using a midline approach. LOR to saline versus air was similar. Median procedure time was 25 minutes. Accidental dural puncture (ADP) rate was 2.1% (23/1072), however only 2 patients required an epidural blood patch.

Conclusions Epidural use for Urology and Thoracic surgery has declined, likely secondary to greater use of laparoscopic/robotic techniques. There may be a resulting overall decline in epidural numbers although the impact of Covid-19 in 2020 prevents us from drawing definitive conclusions. The majority of clinicians adopt similar technical approaches to placement. ADP rate is similar to previously published rates and requirement for blood patching is reassuringly low.