17 August 2010

Questions and answers about epidural analgesia

Here our expert answers questions that are frequently asked about epidural anaesthesia.

What should happen if an epidural does not seem to work well?
The levels of temperature sensation must be tested with an ice cube. If the area is blocked by epidural local anaesthetic, the coldness will either feel warm or it will not be felt at all. If the surgical area is not covered by the anaesthetic, a top-up should be given and the rate of the infusion should be increased.

Why does an epidural sometimes suddenly stop working?

  • There can be a number of different causes, which include the following:
  • There could be an infusion pump failure or a catheter disconnection. The latter can happen when a sudden movement pulls the catheter out of the epidural space.
  • An incorrect mixture, such as when the infusion rate is too low and the spread of the epidural block has become too small.
  • The epidural has been running for a few days and the patient has built up a tolerance.
  • There is a complication in the condition of the patient which is too painful for the epidural to block.
  • There has been a delay of more than 15 minutes in the changeover of infusion bags.
  • The infusion pump or the patient-controlled analgesia (PCA) pump has been set incorrectly or the patient does not understand how to use the PCA pump.


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