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Epidural Analgesia

Debra Lashley- Faria

NR321 Week 6

Tracy Swanston

December 4, 2009
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Epidural Analgesia

Analgesia is now recognized as a significant contribution to clinical outcomes. The goal for

pain management is to provide the best analgesia, with the least amount of side effects. General

Anesthesia is a desirable method of pain relief, as it provides true segmental analgesia with little

or no contribution for systemic levels of opiods, all of which may lead to excellent analgesia

with minimal side effects. There are several benefits to Epidural Analgesia. The benefits are Less

sedation, Earlier ambulation, Decreased incidence of pulmonary complications, Excellent

analgesia, Decreased incidence of venous thrombosis, Earlier return of bowel function,

Decreased stress response. To summarize, the utilization of epidural analgesia would be to say,

postoperative pain is less, utilization of other opiods are less, and our nursing outcomes, to

prevent complications and early mobilization is effective.

Epidural analgesia must always be explained to the patient and family. All its expectations

and side effects should be included, and allow the patient time to ask questions. There are two

types of anesthesia. One that numbs your body from the chest to the legs, where the medicine is

placed directly into the spine area. It¶s usually a spinal or epidural block, but we will focus on the

epidural block. The patient only feels a µpressure µwhen the needle is inserted, but their stay in

hospital is a very short stay with little or no complications. It is imperative once discharged, that

for the first 24 hours, the patient does not drive nor drive alcohol. During an epidural injection,

the patient only stays in bed, until your legs are no longer numb. This epidural injection is a

definite advantage of a short hospital stay.

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cost operative cain Management is a major factor in my perspective. This is especially

beneficial for increased high risk surgical patients, or, for those recovering from extremely large

or painful surgical procedure. E.g. Thoracotomies, major abdominal vascular and orthopedic

surgeries. The epidural infusion provides a localized band of analgesia at site of incision.

Epidural analgesia should only be used in hospital units where staff has adequate training. They

should be knowledgeable concerning epidural catheter placement, epidural medications and

possible side effects and complications.

Epidural Analgesia has its advantages, as it gives the ability to be awake during the

operation, especially in labor, and the ability to avoid complications of general anesthesia. crior

to the procedure, as physicians, it must be documented regarding your drug allergies, medication

taken, any core measures illness, e.g. asthma, pacemaker hypertension diabetes mellitus to name

a few.

Epidural analgesia can cause both anesthesia (1.e., a loss of sensation) and analgesia (i.e., a

loss of pain) by blocking the transmission of signals from nerves in or near the spinal cord to the

brain. It is most suitable for surgical procedures involving the thorax, abdomen, pelvis and lower

limbs because the epidural space is increasingly more difficult to access as one ascends the spine.

It is less commonly used for analgesia for the neck or arms and is not possible following cranial

surgery because sensory innervations for the head are intertwined with the cranial nerves.

Drugs commonly used for pain control via post-operative epidural analgesia, are

combinations of an opioid and a local anesthetic such as bupivacaine and ropivacaine. The

different mechanisms of the two types of drugs create a synergy that yields effective pain control

and minimizes the potential for toxicity from a large dose of a single agent. It is imperative that
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professionals are knowledgeable about the epidural analgesia and its use in the postoperative

setting, so that we can accurately assess patients¶ need. Complications are rare but no procedure

is completely free of risk.

In the United States, ten to twenty percent of all cancer patients do not achieve adequate pain

relief or experience significant side effects while receiving treatment within the Work Health

Organization (WHO) ladder recommendations and guidelines for pain management. cain

management with an epidural can provide acceptable pain relief to many of these patients

(Coyne, 2003). Few large-population clinical investigations have evaluated the incidence of

epidural catheter-related infections. One meta-analysis of studies prior to the year 2005 found

that incidence rates for infectious complications range from 3.7 to 7.2 cases per one hundred

thousand patients for spinal anesthesia-associated meningitis, and from 0.2 to eighty seven

incidences per one hundred thousand for regional anesthesia-associated epidural abscesses.

(Schulz-Stubner, et al., 2008)

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References

1. ·ird, A & Wallis, M (2002). Nursing knowledge and assessment skills in the

management of patients receiving analgesia via epidural infusion. Journal of Advanced

Nursing, 40(5), 522-531.

2. ·lack, C., & Schofield, c. (2008). Invasive procedures for the management of pain.

Journal of Community Nursing. 22 (5), 4, 6, 8.

3. Conlon, N.c. Shaw, A. D., & Grichnik, K.c. (2008). cost Thoracotomies par vertebral

analgesia: Will it replace epidural analgesia? Anesthesiology Clinics, 26(2), 369-380

4. Coyne, c.J. (2003). When the World Health Organization analgesic therapies ladder fails:

The role of invasive analgesic therapies. Oncology Nursing Forum, 30(5), 777-783.

5. Database Nursing Reference Center, Evidence-·ased Care Sheet, ·y Kathleen Walsh,

RN, ·SN, CCRN.

6. Dawson, S. (2001). Epidural catheter infections. Journal of Hospital infections, 47(1), 3-

8.

7. Drug administration. (2009). In J. c. Kowalak (Ed), Lippincott¶s nursing procedures (5th

ed., pp. 329-332). chiladelphia, cA: Lippincott Williams & Wilkins.

8. Hong, J. Y., & Lim, K. T. (2008). Effect of preemptive epidural analgesia on cytokine

response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer.

Regional Anesthesia and cain Medicine, 33(1), 44-51.

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9. Keck, S., Glennon, C., & Ginsberg, ·. (2007). DepoDur extended-release epidural

morphine: Reshaping postoperative care: What preoperative nurses need to know is

Orthopedic Nursing, 26(2), 86-95.

10.Kitcatt, S. E. (2006). Caring for the patient with an epidural in the recovery unit. ·ritish

Journal of Anesthetic and Recovery Nursing, 7(4), 41-43.

11.Lau, W. C., & Eagle, K. A. (2008). Medical evaluation of the surgical patient. In A. S.

Fauci, D. L. Kasper, D. L. Longo, E. ·raunwald, S. L. Hauser, & J. L. Jameson (Eds.),

Harrison¶s principle of internal medicine (17th ed., pp. 49-53). NY: McGraw Hill.

12.Miller, R. D. (2006). Anesthesia. In G. M. Doherty, & L. W. Way (Eds). Current

surgical diagnosis & treatment (12th ed., pp. 170-182). NY: McGraw-Hill.

13.Murdoch, J. (2005). Ensuring prompt diagnosis and treatment of epidural abscess.

Nursing Times, 101(20), 36-38.

14.Nishimori, M., ·allantyne, J.C. & Low, J. H. (2006). Epidural pain relief versus systemic

opiod-based relief for abdominal aortic surgery. Cochrane Database of Systematic

Reviews, (3).