Extradural diamorphine for postoperative analgesia: audit of a nurse-administered service to 800 patients in a district general hospital.

We report the use of extradural diamorphine for postoperative analgesia as a nurse-based service on selected surgical wards in a district general hospital. Eight hundred patients received lumbar or thoracic extradural diamorphine analgesia for postoperative or traumatic pain. Diamorphine was administered in bolus form by suitably trained nursing staff. Satisfactory analgesia, recorded on a verbal rating scale at the conclusion of the service, was achieved in 94.6% of patients. The technique was considered by medical and nursing staff to be a safe and acceptable method of analgesia. Respiratory depression, defined as a ventilatory frequency of less than 10 b.p.m., occurred in seven patients (incidence of 0.9%). All occurred in the theatre recovery area or in the intensive care unit. Retrospectively, each was predictable and all responded to naloxone 0.4 mg.