epidural analgesia

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absence of sensibility to pain, particularly the relief of pain without loss of consciousness; absence of pain or noxious stimulation.
continuous epidural analgesia continuous injection of an anesthetic solution into the sacral and lumbar plexuses within the epidural space to relieve the pain of childbirth, in general surgery to block the pain pathways below the navel, or to relieve chronic unremitting pain.
epidural analgesia analgesia induced by introduction of the analgesic agent into the epidural space of the vertebral canal.
infiltration analgesia infiltration anesthesia.
patient controlled analgesia (PCA) an apparatus used to relieve acute pain. It consists of a pump attached to an intravenous or subcutaneous injection site and filled with multiple doses of medication that are available when the system is activated by the patient. The pump is programmed to “lock-out” the patient for specified intervals making overdosage unlikely.
patient controlled epidural analgesia patient controlled analgesia in which a narcotic or local anesthetic is administered into the epidural space via a catheter.
relative analgesia in dental anesthesia, a maintained level of conscious sedation short of general anesthesia, usually induced by inhalation of nitrous oxide and oxygen.
transdermal analgesia a method of pain control in which a patch with a rate-controlling membrane is applied to the skin; the medication is deposited in the upper layers of the skin where it is absorbed into the systemic circulation.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

epidural analgesia

A technique of managing pain in which narcotics are infused into the peridural space through an indwelling catheter. Administration may be at a continuous basal infusion rate or self-administered within programmed limits.


Epidurally administered medications diffuse across the dura mater, through the arachnoid and pia mater to provide pain relief, and are indicated to treat pain in the thoracic, lumbar, or sacral areas, e.g., in patients in labor or those undergoing thoracic surgeries, and the acute and chronic pain of chronic lumbosacral radiculopathy, cancer pain, phantom limb pain, pancreatic pain, and incisional pain. Epidural anesthesia can be used for surgeries such as cholecystectomy, coronary artery bypass grafting, hysterectomy, arthroplasty, or even abdominal aortic aneurysm repair. Epidural needles and catheters can be inserted at spinal levels C7 to T1 to treat patients with chronic pain symptoms or for surgeries of the arms and shoulders; from T4 to T5 for thoracic surgery; from T8 to T10 for upper abdominal surgery; and at L2 to L3 for lower abdominal surgery and labor and delivery. Drugs for epidural anesthesia include anesthetics such as lidocaine, analgesics such as morphine, or steroids such as methylprednisolone acetate. Epidural anesthesia is contraindicated in patients receiving systemic anticoagulation and antiplatelet therapy, e.g., aspirin products or NSAIDs, patients with abnormal or reduced concentrations of clotting factors, patients in hypovolemic shock, with abruptio placentae, and whenever there is evidence of active infection near the site of the insertion of the epidural catheter. Relative contraindications include history of headaches or backaches, chronic neurological disorders, and allergy to drugs being used.

Patient care

The anesthesia provider discusses the procedure, benefits, and risks with the patient and answers any questions. An informed consent form must be signed by the patient. The nurse may reinforce or clarify information as necessary and witness the patient’s signature on the consent form. Before the procedure the patient should have an IV line infusing lactated Ringer’s solution or 0.9% sodium chloride solution and should have supplemental oxygen via a nasal cannula or simple face mask. Blood pressure and oxygen saturation should be monitored throughout the procedure. The health care professional helps position the patient in the preferred sitting position with head down, shoulders slumped, and arms out in front to bend the back forward and open the vertebral spaces. Legs may be extended forward or hang over the side of the bed or table. If this position cannot be tolerated, the patient is positioned laterally with chin tucked against chest and knees in a fetal position. The patient is assisted to remain still and kept as comfortable as possible; reassurance and emotional support are provided. Once inserted, the epidural catheter is labeled according to the facility’s policy, and properly and prominently identified so that only epidural drugs are administered through it (these are pure, preservative-free medications, not the same formulation as for usual intravenous preparations of the same drug). The patient should then be assisted to a comfortable position or positioned for surgery. Administration of epidural medication and the removal of the catheter are determined by state nursing laws, which nurses must know. Epidural medications are usually administered by a certified registered nurse anesthetist or by an anesthesiologist and are managed by a staff nurse. Drugs given epidurally must be administered with a sterile technique. The dose is determined by the patient's response as the desired level of anesthesia is reached.

The patient should be assessed periodically according to the facility’s policy. His blood pressure, heart rate, respiratory rate, and oxygen saturation should be documented. The insertion site and dressing are examined periodically for bleeding or medication leakage. The patient is assessed for pain from the catheter or from the infusion and for breakthrough pain related to the surgery or for the painful condition being managed. Continuous infusion via a pump or patient-controlled analgesia pump also must be checked for correct functioning. Muscle weakness and sensory loss may be indicators of epidural bleeding and nerve impingement, which requires emergency surgery to prevent permanent tissue and nerve damage. Any problems encountered should be called to the attention of the anesthesia provider. Hypotension is commonly experienced. The patient’s IV fluid infusion rate may need to be increased dramatically to manage hypotension, or a vasoactive agent may be administered as prescribed. Respiratory distress will occur if the needle or catheter enters the subarachnoid space, causing high spinal anesthesia with increased loss of respiratory muscle function. The anesthesia provider and rapid response team should be notified immediately, and basic life support guidelines followed to maintain airway, breathing, and cardiovascular status.

The catheter may migrate into an epidural vein as a result of the patient's movement, causing epidural medication to enter the bloodstream and produce an overdose. Prevention of this complication involves slow, careful movement and repositioning by a caregiver team, with the patient providing minimal aid. If the dura mater is torn by the large needle or catheter during epidural insertion, a cerebrospinal fluid leak into the epidural space can occur. This complication should be suspected if the patient experiences severe and sudden headache when upright. The patient should be kept supine, the anesthesia provider notified, and the patient treated, which may involve administration of additional IV fluid, caffeine, analgesics, or an epidural blood patch. Infection is a rare complication: it is prevented by maintaining sterile technique throughout the insertion, management, and removal of the epidural device.


Excessive sedation, hypotension, respiratory depression, and coma may occur if patients receiving epidural analgesia are also given other central nervous system depressant drugs.
See also: analgesia
Medical Dictionary, © 2009 Farlex and Partners
References in periodicals archive ?
When the patient's pain can be managed by oral analgesics, when the patient's pain is not managed adequately, or when the risk of complications outweighs the benefits, epidural analgesia should be discontinued (Cason, 2019).
This tool can eliminate psychological factors such as personality, age, gender and changes in cultural background, fear, anxiety, depression and anger for pain assessment.6 From this point of view, it can be suggested that sympathetic tonus increase and pain caused by the elimination of the effect of epidural analgesia applied at vaginal delivery may also affect PI.
There are no data on the labour epidural analgesia service at Rahima Moosa Mother and Child Hospital (RMMCH), and the aim of this study was to describe the labour epidural analgesia service at RMMCH over a period of 1 year.
Epidural analgesia remains the mainstay of postoperative care after total hip or knee arthroplasty.
After obtaining approval from the Institutional Ethics Committee and written informed consent, 50 women fulfilling the inclusion criteria who required epidural analgesia in labour were studied.
Epidural analgesia reduced paternal anxiety and stress and increased paternal involvement, participation, and satisfaction with the experience of childbirth [16].
Primiparity (p = 0.001), those who received epidural analgesia (p = 0.004), those who had episiotomy (p < 0.001), and those who had instrumental delivery (p = 0.004) were significantly associated with higher rate of PPUR.
Kaur, "Comparison of epidural analgesia with transversus abdominis plane analgesia for postoperative pain relief in patients undergoing lower abdominal surgery: a prospective randomized study," Anesthesia: Essays and Researches, vol.
Bupivacaine continues to be the most widely used local anesthetic for labor epidural analgesia because it provides an excellent sensory block.
Epidural analgesia offers superior pain relief and early mobilization, especially when local anesthetic dose is combined with an adjuvant as compared to LA use alone.[3] It permits analgesic dosing through the catheter for postoperative pain management.
Walking epidural analgesia on labor reveals lower pain scores, leading to higher maternal satisfaction with better cardiovascular and pulmonary physiology (3).