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Obstacles in organisation of service delivery reduce potential of epidural analgesia

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 …