Epidural Analgesia

Epidural analgesia: For many years, epidurals have been used for pain relief in childbirth. Now, epidurals are used in a number of postoperative settings including lower extremity orthopedic operation, major operations on the chest and abdomen, and certain urological procedures. We can use an epidural for pain control after your surgery by attaching the epidural catheter to a small, computerized pump.

With epidural anesthesia, a thin plastic catheter (which looks much like fishing line) is placed between two bones in your back by an anesthesiologist. This plastic catheter is called an "Epidural Catheter". Where the catheter is placed in your back depends upon the type of surgery you will have and the medicine you will receive. For example, the catheter may be placed in your lower back if you are having knee surgery and higher up for gallbladder surgery.

The catheter will be taped up your back to your shoulder. You may lie on your back without causing any problems. A small pump (which is about the size of a transistor radio or Walkman) will be attached to your catheter after surgery. We use two types of pain medicine to block your pain after surgery: opioids (commonly called narcotics) and local anesthetics. The pain medicine is absorbed through the epidural space, into the nerve roots, in your back . . . hour after hour . . . which diminishes pain after surgery.

Epidural analgesia gives excellent pain relief. This pain control method usually causes less sleepiness than medicine given through your IV or as a shot. Epidural medicine stops your pain early and blocks its path to your brain. Patients may have shorter hospital stays and fewer problems after surgery when they have epidural analgesia.

Epidural pain control may be used for almost any surgery below your upper chest. Patient having surgery on the aorta, gallbladder, prostate, knee, and hip can find this type of pain control valuable. Women who have hysterectomies could find this a good method of pain relief; children too can benefit from this method of pain control.

Some patients may not have the option of using this type of pain control because of other health care problems, such as taking blood thinners. You may want to ask your surgeon if epidural pain control would be good for you.

Epidural pain control will be used only if you, your surgeon, and the anesthesiologist all agree that this is a good pain management plan. If you feel you would like an epidural for pain control after surgery, please ask. An anesthesiologist can discuss an epidural with you in more detail and answer your questions. We support quality pain control and encourage you to help make decisions about your health care and pain management.

• The nurse will check on you often.
• You will be asked to describe how much pain you are having by using a 1 to 10 scale (zero means you have no pain; ten means the worst pain you can possibly imagine). Or, you may be asked to describe your pain using other words to help us understand how much pain you are having.
• You will be asked about your satisfaction with pain control and how comfortable you are.
• DO NOT GET OUT OF BED WITHOUT HELP FROM YOUR NURSE!!
• Inform your nurse if you have pain, nausea, or itching. Also tell your nurse if you have weakness or numbness in your legs, or if you are lightheaded. These things can be treated.

• ITCHING is rather common but tends to be mild. It can be treated easily if you tell your nurse.
• NAUSEA AND VOMITING happens in 5-15% of patients. Anti-nausea medicine can be given for this.
• DIFFICULT URINATION may be the result of your surgery, other medicine, or the epidural. A drainage catheter into your bladder may be needed to drain your urine.
• NUMBNESS is caused by the local anesthetic (it is much like the medicine the dentist gives). It can cause weakness; tell your nurse if this happens! The strength of the medicine may need to be changed.

Any form of pain management has a cost. The hospital charges for supplies and medicines. The Department of Anesthesiology participates with all insurance companies and accepts their payment as full payment for care given, including epidural pain control. One exception: If you have co-pay insurance, a part of the total bill will be sent to you.