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Julie Watkinson- Pain Control Nurse Specialist. EPIDURAL ANALGESIA. 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

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Presentation Transcript
objectives
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
epidural analgesia
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
pre operative assessment
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
anatomy of the spine
Anatomyof the spine
  • The epidural space lies between the wall of the vertebral canal and the dura mater
siting an epidural catheter
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
where are epidurals sited
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?

slide8

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.
slide9

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
slide10

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
inadequate pain management
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

complications of epidural analgesia
Complications of epidural analgesia
  • Epidural abscess
  • Epidural haematoma
  • Spinal headache
  • Nerve damage
  • Paraplegia
  • Meningitis
issues related to pain management
Issues related to pain management
  • Referred pain - shoulder pain

wound pain

  • Nausea and Vomiting
  • Hypotension
  • Urine output
  • Sedation
  • Mobilisation
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

Advantages v Disadvantages
conclusion
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)