Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiaClinical use of epidurals[Appraised by Sister Sue Millerchip, January 2010; guidelines supplied bySister Sue Millerchip]Epidurals are widely used for thoracic, abdominal and limb surgery.The most common reasons for inadequate epidural analgesia are:• Failure to site them in an appropriate place (at the midpointdermatome of the surgery).• Failure to manage poor analgesia properly (see page 132).Epidural analgesia infusions are managed only in general andcardiothoracic critical care areas, and on the enhanced care unit(ECU) on ward 22. Hospira Gemstar electronic infusion pumps areavailable. Infusion bags are prepared by Pharmacy and kept in thecontrolled drugs cupboards. They contain bupivacaine 1 mg mL -1 andfentanyl 2 µg mL -1 .Effective use of epidurals1. You should establish epidural blockade at an appropriate levelfor the surgical incision. Consult with the surgeon as to theexpected extent of the incision.2. If you cannot do this, consider using intrathecal morphine (seepage Error! Bookmark not defined.).3. Deal robustly with failure, including resiting the epidural orswitching to systemic analgesia.4. Do not send patients away from the theatre suite with a painscore of 2 or more.Trust guidelineThis guideline was written by Sue Millerchip and last reviewed in2009. Pertinent points for anaesthetists are listed in the followingsections, taken from the guideline.128 Anaesthetists Handbook January 2010