Download Julie Watkinson- Pain Control Nurse Specialist

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
• Discuss epidural pain management and
related issues
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
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
•
The epidural space lies between the wall of the vertebral canal and the
dura mater
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
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?
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.
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
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
• 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
•
•
•
•
•
•
Epidural abscess
Epidural haematoma
Spinal headache
Nerve damage
Paraplegia
Meningitis
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
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)