Continuous Epidural Infusion for Pain Relief
Continuous epidural infusion is a way to give pain medicine. The medicine is sent to the spinal cord and nerves through a soft tube (catheter) into the area known as the epidural space. This space surrounds your spinal cord. Pain signals in part of your body are then blocked. Continuous epidural infusion is often used to treat pain after surgery. It is often put into place before an operation and can stay in place for the first few days of recovery. An epidural is used when a healthcare provider believes that it will give better pain relief than pain medicines taken by mouth or given directly through the veins.
How an epidural works
Pain signals from nerves in the affected part of your body travel up the spinal cord to your brain. An epidural blocks nerve signals from traveling along the spinal cord. This keeps the signals from reaching your brain and keeps you from feeling pain. A thin, flexible tube (called a catheter) is used. It is put through the skin of your back into the part of the spinal canal surrounding the spinal cord called the epidural space. Medicine is then sent through the tube. It blocks nerves below the point where the tube is inserted. The medicines either reduce pain or block most feeling.
The epidural insertion
The epidural may be put in before surgery or just after surgery. If you are awake for the insertion, you may be asked to lie on your side and pull your knees up to your stomach. Or you may be asked to sit on the side of your bed and lean over. The skin where the epidural will be placed is cleaned and numbed with a local anesthetic. The tube is placed into your back. A small machine pumps pain medicine through the tube. The pump is programmed and adjusted by the anesthesiologist. In some cases, you will be shown how to give yourself medicine as needed.
When the epidural is in place
You may be able to move around and walk with the epidural in place. Ask your healthcare provider before trying to walk with an epidural in place.
The medicine may make you unable to empty your bladder. If this happens, the amount of epidural medicine may be adjusted. Or, a tube is placed into your bladder to drain it.
If you have certain symptoms, your medicine may be adjusted. Tell your healthcare provider if you:
Still have pain
Have a headache
Have trouble breathing
Start having itchy skin
Have less feeling in or ability to move your legs
Have pain at the epidural insertion site
Feel confused or dizzy
The epidural can be left in place for several days. It will be removed before you go home.
Risks and possible complications of continuous epidural
Though it is safe, continuous epidural can have complications. These may include:
Sudden drop in blood pressure
Spinal cord damage
Nerve or blood vessel damage
Your healthcare provider or nurse will watch carefully for these complications while the epidural is in place.
May 09, 2017
Neuraxial Analgesia and Anesthesia for Labor and Delivery: Options. UpToDate, Practice Guidelines for Acute Pain Management in the Perioperative Setting An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Apfelbaum, J. Anesthesiology. 2012, is. 116, ed. 21, pp. s248-73.
Moe, Jimmy, MD,Taylor, Wanda, L., RN, PhD