Julie Watkinson- Pain Control Nurse Specialist

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Julie Watkinson- Pain Control Nurse Specialist

• EPIDURAL ANALGESIA

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OBJECTIVES

• Identify which patients are suitable for Epidural
  Analgesia
• Give an overview of the anatomy of the spine
• Describe the placement of an epidural catheter
  and the drugs used for epidural pain management
• Discuss epidural pain management and related
  issues
  
  
  

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Epidural Analgesia

• The name epidural describes the anatomical
  location of the injection
• Epi -means surrounding the centre
• Dural -stems from the Greek word for hard and
  signifies the region of the spine known as the
  dura

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Pre -Operative Assessment

• The anaesthetist visits the patient the day prior
  to surgery
• Consideration is given to-
• Previous medical history
• Patient understanding and consent
• Nature of surgery
• Contra-Indications / Drug interaction
• Patient compliance

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Anatomy of the spine

• The epidural space lies between the wall of the
  vertebral canal and the dura mater

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Siting an Epidural Catheter

• Using an Aseptic Technique is essential
• Epidural Tuohy needle is used and inserted
  through the skin?intervertebral space?and into
  the epidural space
• The tuohy needle is then removed
• An antibacterial filter and infusion line are
  connected and epidural infusion commenced

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Where are Epidurals sited

• Epidurals can be sited at any level of the spine
• Cervical
• Thoracic
• Lumbar
• Patients undergoing cardiac or thoracic surgery
  usually have epidurals sited in the thoracic
  region
• WHY?

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• When is an epidural catheter inserted?
• Prior to surgery in the anaesthetic room
• Awake
• Asleep
• When is an epidural commenced?
• During surgery for inter-operative pain
  management
• Following surgery for a number of days depending
  on patients individual needs.

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• What drugs are used?
• Fentanyl - Opiate
• Bupivicaine - Local Anaesthetic
• Pain Management
• How can we assess if epidural analgesia is
  effective?
• Complete pain assessment charts
• Use the information to assess level of pain

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• Pain Management continued...
• Assess motor response
• Check the level the epidural has been sited in
  comparison with the rate of the epidural
• Is the patient experiencing side effects?
• Most importantly ask the patient

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Inadequate pain management

• Pain scores of two or more are unsatisfactory
• Increase rate of epidural depending on
  prescription
• Ensure epidural is working
• line remains in place
• no occlusion present
• Determine change in patients condition
• Infection or New surgical problem

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Complications of epidural analgesia

• Epidural abscess
• Epidural haematoma
• Spinal headache
• Nerve damage
• Paraplegia
• Meningitis

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Issues related to pain management

• Referred pain - shoulder pain
  
• wound pain
• Nausea and Vomiting
• Hypotension
• Urine output
• Sedation
• Mobilisation

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Advantages v Disadvantages

• Achieves quality pain relief for 3-7 days
• Enables the patient to participate in
  physiotherapy
• Enables patient to cough and expecturate

• Risk of complications
• Side effects may be unpleasant
• reduces full mobilisation

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Conclusion

• epidural analgesia with a continuous infusion of
  a local anaesthetic / opiod mixture is currently
  the most effective method of providing pain
  relief.. for major thoracic surgery.
• The Royal College of Anaesthetist
• (2000 p70)