The Use Of Epidural Analgesia Pre And Post MASTER Study In A New Zealand Tertiary Hospital

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Gavin Werrett¹, Richard French¹, Richard Craig², Hamish Horton¹1 Department of Anaesthesia, Christchurch Hospital, Christchurch NZ
2 Acute Pain Management Service, Dept of Anaesthesia, Christchurch Hospital, Christchurch NZ

Purpose of study

The MASTER study (Lancet, April 2002) was a major prospective study evaluating the effect of post-operative epidural analgesia (EA). The results suggested only modest benefit from EA and were published in 2002. We reviewed EA and IV Patient Controlled Analgesia (PCA) usage before and after MASTER publication to assess whether practice had been influenced.

Methods

Pain service audit records were reviewed to obtain total EA and PCA number for the six 12 month periods between 01 June 1999 and 31 May 2005. The MASTER trial was published in April 2002 meaning our “Post MASTER period” starts 2 months after publication.
To identify EA usage in a specific surgical cohort “GA only” and “GA+EA” numbers for colonic surgery were obtained using the clinical coding records of Canterbury District Health Board. Specialists present in the department during the study time were surveyed on whether their practice had changed and why in this time period.

Result

Mean annual EA usage Pre MASTER was 368 and post MASTER was 197. Comparing use of EA vs PCA for the three year epochs a reduction in usage is seen (Pre-MASTER EA:1030 PCA:4455, Post-MASTER EA:592 PCA:5520. p< 0.001, Chi2). Considering colonic surgery EA was used in 195 of 641 (30%) cases Pre-MASTER and 80 of 602 (13%) cases post-MASTER (P<0.001).

Thirty-six of thirty-seven specialists surveyed replied. 69% felt MASTER had influenced their practice resulting in a decrease in usage.

Conclusion

The temporal association of MASTER publication with the decline in usage of EA, plus the response of the surveyed specialists, suggests that MASTER publication was associated with a major shift in practice. Whilst other factors undoubtedly existed they had not gathered sufficient weight to precipitate the change. We believe MASTER acted as a “tipping point” for a change in practice.