• Matthieu Jabaudon, Russell Chabanne, Achille Sossou, Pierre-Marie Bertrand, Sophie Kauffmann, Christian Chartier, Renaud Guérin, Etienne Imhoff, Lassane Zanre, François Brénas, Jean-Etienne Bazin, and Jean-Michel Constantin.
• Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; R2D2 (Retinoids, Reproduction and Developmental Diseases)-EA 7281, School of Medicine, Université d'Auvergne Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: mjabaudon@chu-clermontferrand.fr.
• Anaesth Crit Care Pain Med. 2015 Aug 1; 34 (4): 217-23.

BackgroundEpidural analgesia (EA) has been more investigated during the perioperative period than in the intensive care unit (ICU) setting. Recent studies support beneficial effects for EA beyond analgesia itself. However, data on feasibility and safety are still lacking in the ICU. Our goal was to assess the feasibility and practice of EA in ICU patients.MethodsMulticentre observational study in 3 ICUs over a 10-month period. Goals were to report the incidence of EA-related complications and EA duration. All ICU patients receiving EA were included, whether EA was initiated in the ICU or elsewhere, e.g. in the operating room. Demographics, clinical and biological data were prospectively recorded. Epidural catheter tips were sent to the microbiology laboratory for culture.ResultsOne hundred and twenty-one patients were included (mean age 60 years), with mean SOFA and median SAPS II scores of 3.2 and 32, respectively. Reasons for EA initiation included trauma (14%), postoperative pain management after major surgery (42%), and pancreatitis (31%). No EA-related neurologic complication was recorded, and one case of epidural abscess is discussed. No other EA-related infectious complications were observed. Median duration of EA was 11 days. Reasons for EA discontinuation included efficient analgesia without EA (60%) and accidental catheter removal (17%). 22% of epidural catheter cultures were positive for skin flora bacteria.ConclusionEA seems feasible in the ICU. Its apparent safety should be further validated in larger cohorts, but these preliminary results may stimulate more interest in the assessment of potential benefits associated with EA in the ICU setting.Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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