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Epidural Infusion vs IV Patient Control Analgesia

Epidural Infusion vs IV Patient Control Analgesia. Ms Josephine PY Chen, RN. Acute Pain Service Data PWH 1/2003 – 12/2003. n=1793 PCA=1478, 80.5% CEI=261, 14.3% Others=54, 5.2%. Service Data Cont ’ d. Pain Score at termination (on exertion): PCA : 0=3.5% CEI: 0=20.9%.

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Epidural Infusion vs IV Patient Control Analgesia

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  1. Epidural Infusion vs IV Patient Control Analgesia Ms Josephine PY Chen, RN

  2. Acute Pain Service Data PWH1/2003 – 12/2003 n=1793 PCA=1478, 80.5% CEI=261, 14.3% Others=54, 5.2%

  3. Service Data Cont’d Pain Score at termination (on exertion): PCA: • 0=3.5% CEI: • 0=20.9%

  4. Service Data Cont’d Pain Score at termination (on exertion): PCA • 8-10=3.2% CEI: • 8-10=3.5%

  5. Service Data Cont’d Satisfaction Score at termination: • PCA=49.2%> 8-10 • CEI=68.1% > 8-10

  6. Service Data Cont’d Premature Termination • CEI=11% • Because of :ineffective; haemodynamic unstable; catheter dislodged; signs of infection, etc.

  7. Epidural It works →comfortable PCA Re-educate Especially in elderly & children Compliance

  8. Education for PCA • Handset control • Timing • Rehab. activities involvement • Intervention for side effects: reassurance, medications, program, close monitoring

  9. Education for CEI • Beware of the epidural catheter • Allow mobilization • Beware of motor weakness / sensory deficit

  10. Which modalities require more nursing attention? • Epidural or PCA?

  11. Nursing attention • Both modalities • Crucial in first 24 hours

  12. Rare Same RR < 10/min If SpO2 < 95% on room air, O2 supplement Specific observationsRespiratory depressionEpidural PCA

  13. Rare Hallucination Rare Drowsy Dose related SedationEpidural PCA

  14. Hypotension Epidural Rule out : surgical complications; hypovolaemic; on antihypertensive; in subarachnoid PCA Rare

  15. Adjust infusion rate / rescue bolus Drug concentration Epidural catheter Adjust PCA program / bolus Education IV access Handset dislodge Side effects Pain ControlEpidural PCA

  16. Monitor BP/P Extension of motor & sensory blockade Routine No drastic side effects After rescue bolus Epidural PCA

  17. Signs of: infection local / systemic persistent / swing T↑38°C redness @ catheter site IV access Side effects Subsequent observationEpidural PCA

  18. Pre-placement Coagulation Epidural Exclude coagulopathy Stop anticoagulants PCA Nil Cautions

  19. Heparin Standard Heparin 5,000u • Avoid placement within 4-6 hours after a dose • Subsequent dose 2 hr later

  20. Low molecular weight heparin • Avoid placement within 12 hours after a dose • Subsequent dose 2 hours later

  21. Warfarin • Contraindicated

  22. No other opioids or sedatives Preferably no anticoagulants Rescue drug Ephedrine Same Not a concern Naloxane While receivingEpidural PCA

  23. Optimization • Maintain stable analgesic level • Low analgesic level takes time to titrate

  24. Co-analgesics Check clotting Stop anticoagulants SH: 6 hrs prior LMWH: 12 hrs Same Not a concern Before cessationEpidural PCA

  25. Tip intact Skin integrity Signs of infection Heparin/LMWH resume 2 hrs later Less concern CessationEpidural PCA

  26. Epidural site Motor / sensory function Unless indicated Subsequent FUEpidural PCA

  27. General Principles of Nursing Care • Analgesics ≠nursing care • Change position • Handle injured or swollen parts / tissues • Maintain body alignment • Prevent over taxing patient→↓pain threshold

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