Letters

Obstacles in organisation of service delivery reduce potential of epidural analgesia

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1499b (Published 04 December 1999) Cite this as: BMJ 1999;319:1499
  1. Huw Talfryn Oakley Davies, reader in healthcare policy and management,
  2. Graeme McLeod, consultant anaesthetist (g.a.mcleod@dundee.ac.uk),
  3. Jonathan Bannister, consultant anaesthetist,
  4. William Andrew Macrae, consultant anaesthetist
  1. Department of Management, University of St Andrews, St Andrews, Fife KY16 9AL
  2. Ninewells Hospital and Medical School, Dundee DD1 9SY

    EDITOR—The editorial by Buggy and Smith paints an overoptimistic view of the benefits of epidural analgesia.1 We agree that there is strong evidence that reducing the afferent barrage attenuates the physiological response to surgery, with great benefit to the patient. But the authors gloss over the practical challenge of attaining consistently effective epidural analgesia in the postoperative phase.

    An audit of postoperative …

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