Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiaAntiplatelet drugsNSAIDS (including low dose aspirin): no restrictions.However, in patients with platelet dysfunction, thrombocytopenia or incombination with any other anticoagulants, seek further medicaladvice.ClopidogrelFor patients taking clopidogrel, an interval of 7 days should elapsebefore epidural catheterisation.Subsequent analgesiaIf the epidural infusion is abandoned, appropriate alternativeanalgesia must be prescribed and instituted. If the epidural hascontained fentanyl it is usually safe to administer systemic opiates.If morphine or diamorphine have been administered spinally orepidurally in the previous 24 hours, the patient must be givenintravenous PCA morphine for analgesia and no other systemicopiates unless specifically directed by the consultant anaesthetistresponsible for the patient.The actions taken must be clearly documented in the case notes.There should be an overlap of pain therapies so that the subsequentregimen has time to take effect before the first is withdrawn e.g.1. Commence prescribed IV PCA.2. Reduce rate of epidural by 50% for the next hour.3. Reduce rate of epidural by a further 50%.4. Stop epidural.To increase the efficacy of intravenous PCA all patients should haveregular paracetamol prescribed and a non steroidal anti-inflammatorywhere appropriate.Anaesthetists Handbook January 2010 139