Through decades of use, the epidural catheter has become a popular and integral analgesia modality for many types of patients (Graber, 2013; Nimmo & Harrington, 2014; Yarnell, 2013). Since initial use in 1947, it has come to play a significant role in current interventional pain management for short-term and chronic conditions (Chawla, 2013). Nursing care responsibilities are equally significant, and are critical for preventing complications and ensuring effective pain management. In this column, short-term, postoperative epidural catheter use for analgesia is outlined. A brief review of spinal anatomy is provided to describe catheter placement. Key aspects relating to indications, complications, and nursing management are highlighted. Show
Spinal Anatomy Spinal vertebrae comprise five levels: cervical, thoracic, lumbar, sacral, and coccygeal (Chawla, 2013). The epidural space contains fatty tissue and extends through the length of the spine, from skull base to sacrum. It lies between the vertebral canal and the dura mater. Blood vessels, lymphatic vessels, and nerves traverse the epidural space. The dura mater covers the spinal cord and contains cerebrospinal fluid. A nerve root bundle called the cauda equina is located within the walls of the dura mater below the inferior end of the spinal cord in the lumbar region. Figure 1 depicts the thin epidural catheter being threaded through a needle inserted between vertebrae and into the narrow epidural space (Intensive Care Hotline, 2015). Medication then can be administered to target specific nerves for pain management. Indications The specific indication for analgesia (e.g., total knee arthroplasty vs. thoracotomy) dictates the level of spinal insertion and placement for the catheter (Chawla, 2013). Further discussion regarding catheter insertion is not within the scope of this article. See Table 1 for examples of patient indications for epidural analgesia catheter placement. Listed indications may or may not be combined with general or spinal anesthesia (Chawla, 2013; Nimmo & Harrington, 2014; Yarnell, 2013). Common medications ordered for epidural infusion include bupivacaine (Sensorcaine[R]), ropivacaine (Naropin[R]), preservative-free fentanyl, hydromorphone (Dilaudid[R]), and morphine (Astramorph PF[R]) (Graber, 2013). Dosages and infusion rates vary because local anesthetics and opioids may be combined for maximum effectiveness (Chawla, 2013; Graber, 2013; Yarnell, 2013). Nurses must be knowledgeable regarding administered medications, and readily recognize and report signs and symptoms of developing side effects or complications (Chumbley & Thomas, 2010). Combined dosing is common. Medications also may be administered as a bolus or continuous infusion (Nimmo & Harrington, 2014). Programmable pumps are used to allow a continuous basal infusion rate, as well as allow the patient to receive additional bolus medication doses independently for break-through pain. The patient presses a button, prompting a prescribed bolus dose to be administered through patient-controlled epidural analgesia (PCEA) (Chawla, 2013; Yarnell, 2013). Specific training is required of nurses who monitor programmable pumps and PCEA. Complications and Contraindications M.O. is a 54-year-old professional golfer who arrived on the medical-surgical unit last evening after having right lower extremity vascular surgery. In addition to receiving intravenous fluids and having an indwelling urinary catheter, the patient has a lumbar... Get Full Access Gale offers a variety of resources for education, lifelong learning, and academic research. Log in through your library to get access to full content and features! Epidural analgesia continues to have an important role in the management of acute pain in post-operative settings. Although its use in clinical practice has declined, it continues to demonstrate superior analgesia effect compared with parenteral opioids. However, despite these benefits, epidural analgesia requires additional monitoring to ensure the timely identification of significant complications, such as haematoma and abscess. This article details the nursing care and management of adults receiving epidural analgesia in post-operative settings. It also outlines the main complications that may occur and how these can be managed. Nursing Standard. doi: 10.7748/ns.2020.e11573 Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software @boywonder1989 CorrespondenceConflict of interestNone declared Galligan M (2020) Care and management of patients receiving epidural analgesia. Nursing Standard. doi: 10.7748/ns.2020.e11573 How to assess epidural blockade.Digital Edition: How to assess epidural blockade. 14 March, 2006 Epidural analgesia is extensively used to manage acute and chronic pain in a variety of clinical settings. It is a high-tech mode of analgesia that may be safely managed by ward nursing staff following appropriate support and training (Cox, 2001).  To continue reading this clinical article please log in or subscribe. Subscribe for unlimited access
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Register Already have an account, click here to sign in Which assessment is most important to monitor after the administration of epidural anesthesia?During anesthesia administration, maternal BP and fetal heart rate should be monitored. The extent of dermatomal sensory loss and motor block should be evaluated at regular intervals. Respiratory monitoring should be performed every hour.
What are the nursing responsibilities during administration of epidural anesthesia?Nursing care for patients receiving epidural analgesia focuses on safely administering analgesia, achieving optimal pain control, and identifying and managing adverse reactions or complications.
What should I watch for epidural?Side effects Epidural. Low blood pressure. It's normal for your blood pressure to fall a little when you have an epidural. ... . Loss of bladder control. ... . Itchy skin. ... . Feeling sick. ... . Inadequate pain relief. ... . Headache. ... . Slow breathing. ... . Temporary nerve damage.. What should be checked in a patient with an epidural in addition to epidural related observations?Check catheter at insertion site for leaking/dislodgement. Check epidural catheter position at the skin insertion site. Check at connection of catheter and filter for disconnection/leaking. Consider surgical review if risk of surgical complications, e.g. compartment syndrome, infection or haemorrhage.
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