Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Assessment and treatment optionsEpidural anaesthesia and analgesia1. Exclude any other cause of pain resulting from a post-operativecomplication for example – pain at sites distant to the incisionand related to the surgery but not covered by epidural analgesiasuch shoulder tip pain.2. If pain appears to be related to the surgery the followingprocedures can be tried:• Measure height of epidural block to establish presence orabsence of block – if greater than T4 do not proceedfurther.• Measure BP and pulse to ensure they are within normallimits – if not stabilise as required and seek further advicefrom the on-call anaesthetist / pain team.• Administer a 5 mL bolus of epidural mix via the infusionand check vital signs every 10 minutes for 30 minutes.• Consider increasing epidural rate within the prescribedlimits.• Repeat 5 mL bolus ONLY ONCE MORE if moderate orsevere pain persists and seek anaesthetic / pain teamreview.• Further boluses need to be prescribed by anaesthetic staffon the drug chart.3. If the patient has a block on one side only this is called aunilateral block and occurs when the tip of the catheter exits theepidural space through an intervertebral foramen. This willrequire further anaesthetic / pain team review as it may benecessary to withdraw the epidural catheter, administer a largerbolus dose or convert the patient to an alternative form ofanalgesia.4. Paracetamol and NSAIDs may be given regularly if appropriatein conjunction with epidural analgesia.Anaesthetists Handbook January 2010 133