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Care of the patient receiving epidural analgesia

“…It is important to understand that even when the epidural infusion has been discontinued, there may be 12 hours of opioid waiting to be absorbed in the spinal tissues. Therefore patients can be at risk of opioid-related side effects for many hours after discontinuation (Macintyre and Schug 2007). Side effects may include respiratory depression, sedation, nausea and vomiting, pruritus, hallucinations and vivid dreams.…”

“…This can be achieved by diluting naloxone and only giving 50mcg at a time. Naloxone will wear off after 60 minutes and therefore a naloxone infusion may be required (Macintyre and Schug 2007). If the patient is not breathing then basic life support should be commenced.…”

“…The most commonly used local anaesthetics are bupivacaine, levobupivacaine and ropivacaine (Dougherty andLister 2004, Macintyre andSchug 2007). Local anaesthetics work by blocking the sodium channels in the nerve, thereby preventing the generation and conduction of impulses, which either slows or stops pain transmission (Scott 2009).…”

“…Therefore, blood pressure can drop quickly in a patient who becomes dehydrated. The treatment is to replace circulating volume with intravenous fluid (Dougherty andLister 2004, Macintyre andSchug 2007). The epidural infusion rate should not be decreased, as this will cause the patient to experience pain, though it may be stopped temporarily.…”

“…Motor block produces a paralysis of the lower limbs which is distressing for the patient. The treatment is to reduce the rate of the infusion (Dougherty and Lister 2004, Macintyre and Schug 2007). Often a reduction of 0.5-1ml can reduce the motor block, but still maintain the sensory block.…”