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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

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Julie Watkinson- Pain Control Nurse Specialist

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  1. Julie Watkinson- Pain Control Nurse Specialist EPIDURAL ANALGESIA

  2. 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

  3. 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

  4. 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

  5. Anatomyof the spine • The epidural space lies between the wall of the vertebral canal and the dura mater

  6. 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

  7. 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?

  8. 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.

  9. 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

  10. 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

  11. 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

  12. Complications of epidural analgesia • Epidural abscess • Epidural haematoma • Spinal headache • Nerve damage • Paraplegia • Meningitis

  13. Issues related to pain management • Referred pain - shoulder pain wound pain • Nausea and Vomiting • Hypotension • Urine output • Sedation • Mobilisation

  14. 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

  15. 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)

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