Ward Nurses' Use of Epidural Analgesia When Treating Breakthrough Pain: A National Survey Study

Epidural analgesia is an effective postoperative pain treatment reducing the administration of systemic opioids and improving postoperative outcomes. Evidence suggests that epidural analgesia improves pain management, improves physical function, reduces nausea and sedation, and patients have a better recovery. Still studies have shown ward nurses lack education in epidural pain treatment. Our study investigated ward nurses' use of in situ epidural catheter for pain treatment when patients experience breakthrough pain. Furthermore, we explored if educational programs are available, and the barriers experienced by ward nurses when treating breakthrough pain in patients with an epidural catheter.

Our study is a Danish nationwide electronic survey targeting all abdominal and orthopedic surgical wards. Head nurses from each ward appointed two ward nurses to answer the questionnaire. The survey took place from March to July 2023.

In all, 104 of 121 (86%) ward nurses completed the questionnaire. Seventy-five (72.1%) respondents reported using epidural bolus as a first-line treatment for breakthrough pain. Education in epidural analgesia was available at 98% of the surgical wards. Further, 47% reported getting formalized education, with 37 (36%) receiving it from a nurse or doctor from either the anesthesiology department or pain team. The most frequent barriers to using epidural bolus were organizational (56%) and lack of competence (42%).

Our study found that 72% of the respondents used epidural analgesia as first-line treatment. Our study also found that 47% of the respondents received formalized education, and the main reported barriers to using epidural bolus were organizational and lack of competence. The high rate of epidural bolus as first-line treatment might reflect best practice in the involved departments.