Epidural Analgesia

An epidural is an anesthetic delivered through a catheter (small tube) into a potential space outside the spinal cord called the epidural space. Using this catheter, we are able to infuse a solution that usually includes a local anesthetic and opioids. The local anesthetics commonly used are bupivacaine and ropivacaine, and they are usually combined with a small dose of fentanyl or hydromorphone.

The anesthetic agents that are infused through the small catheter block spinal nerve roots in the epidural space and the sympathetic nerve fibers adjacent to them. Depending on the location of the catheter, epidural analgesia can be used to help relieve pain associated with chest, abdominal, and lower extremity surgery.

• Better pain control than intravenous narcotics
• Earlier recovery of bowel function
• Less need for systemic opioids and less nausea
• Easier breathing resulting from better pain control
• Easier and earlier participation in physical therapy

A member of the anesthesiology team will speak to you and answer all questions regarding the epidural procedure. During the epidural procedure, we will monitor all of your vital signs (blood pressure, ECG, oxygen saturation). You will also have a nasal cannula, which will provide you with supplemental oxygen in order for us to provide you with sedation medications as needed during the procedure. In order to perform the procedure, you will be placed in a sitting position with your head resting on a table and with your back pushing out towards the anesthesiologist. On occasion, we may perform the procedure while you lie on your side.

The anesthesiologist will feel your back, clean your skin with an antiseptic (bacterial-killing solution), and place a sterile drape around the area. He/she may inject local anesthesia into the skin and deeper tissues of the lower back which may cause a burning or pressure sensation. The anesthesiologist will then advance a needle into the epidural space, which lies outside of the dural sac which contains the spinal cord and fluid. A small catheter will then be inserted into proper position and the needle will be removed. This catheter will be taped to your back and connected to an infusion pump, which will provide the anesthetic that will provide you with pain relief.

You may be receiving patient-controlled epidural analgesia or PCEA. What this means is that you will be receiving a continuous infusion of the epidural medication and you will also have a control button which you can press to receive additional medication if needed.

Although we would like to take away all the pain, in reality, we cannot remove the pain completely. Our aim is to make you as comfortable as possible. The epidural analgesia will provide you with a "band" of decreased sensation in the area where you have the most pain. Depending on the area of coverage, you may also feel heaviness or numbness of your legs.

You will also be prescribed oral pain medications as part of a multimodal approach to your pain management. You will begin taking those as soon as your surgeon clears you for oral intake. The goal is to expedite your recovery after surgery and your discharge from the hospital.

Because of significant advances in technology and medications, epidurals are extremely safe. However, there are some possible risks and complications.

• A decrease in blood pressure usually treated with intravenous fluids
• Headache - May occur secondary to leakage of spinal fluid. Usually treated with IV fluids, caffeine, and oral pain medications.
• Patients sometimes have soreness at the site of the catheter insertion for a few days. It should not cause back pain for a long period of time.
• Caused by the narcotic in the epidural infusion. Can be treated with Benadryl and/or by decreasing the dose of narcotic you are given.
• Weakness of the legs - Depends on the level and density of the block

You will be monitored while having an epidural. When the epidural is being placed and during surgery, you will be under the care of the anesthesiologist. Once you are on the floor, the nursing personnel will check on you frequently and a member of the acute pain service will also check on you each day to make sure you are comfortable. You can also press the nurse call button whenever you need any help.

The goal is to provide you with pain relief for as long as needed. For most patients, after the first 48-72 hours we will transition you to oral pain medications and discontinue the epidural catheter.