Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia7. The patient’s blood pressure should be monitored every fifteenminutes for one hour after any change in infusion, includingcessation, hourly for the first 24 hours and two-hourly thereafterif stable.8. The syringe must be changed every 24 hours.9. Overall responsibility for the infusion remains with the initiatinganaesthetist. The Acute Pain Team should be the initial contactbetween 8am and 5.30pm – bleep 2492/3 and outside thosehours the on-call anaesthetist on bleep 2813.Discontinuation Guidelines1. The infusion will usually run for 24-48 hours at the direction ofthe anaesthetist.2. The infusion should be stopped in two stages unless directedotherwise.3. The rate should be halved and a stat bolus of gelofusine 250 mLgiven. This should be prescribed in advance by the initiatinganaesthetist.4. Two hours later stop the infusion and give a further 250 mLgelofusine.5. If the epidural is stopped during the first 48 hours then themetaraminol should also be stopped as above.6. Hypotension that persists after this should be treated by othermeans following medical review.Management of inadequate epidural analgesiaDefinitionAnalgesia by any route is inadequate if the patient is uncomfortableand reporting a pain score of 2 or 3 (moderate or severe) or is unableto take a deep breath following abdominal or thoracic surgery.132 Anaesthetists Handbook January 2010