Epidural Pain Control For Adults

GENERAL INFORMATION:

What is it? Epidural (eh-pih-DER-ull) pain control means putting pain medicine into the space around the spinal cord in your back. This area is called the epidural space. Using an epidural for pain control is a way to use pain medicine without the need for repeated injections (shots).

When is an epidural catheter used to control pain? Epidurals have been used to decrease the pain of childbirth for many years. Now epidurals can be used to treat pain caused by many different conditions. Epidurals can help decrease acute (short-term) pain, like after surgery or an accident. They can also be used to decrease chronic (long-term) pain, like cancer pain.

How is the epidural catheter put in?

• A temporary (short-term) catheter can be put in your back in the operating room or in your bed in the hospital. It may also be inserted in your caregiver's office. You will lie curled up on your side or in a sitting position on the side of the bed. The skin on your back is washed and then numbed with medicine to decrease feeling and pain. A needle is put in between 2 bones in your back. A very thin plastic tube (like a fishing line) called a "catheter" is threaded through the needle. The catheter puts medicine into the epidural space. With a temporary epidural, the catheter is taped to the skin on your back and shoulder.
  
  
• You will go to the operating room to have a permanent (long-term) catheter placed in your back. You may be given medicine to make you go to sleep while the catheter is put in. The permanent epidural catheter comes out of a small incision (cut) on your side or on the front of your body near your belly button. This is called the "exit site". You will also have small cuts with stitches in your back and side. This is where the catheter was put under your skin. After having an epidural catheter put in, you can still lie on your back to rest or sleep.

How does an epidural work? A small pump attached to a syringe (suh-RINJ) filled with pain medicine is hooked up to the catheter. There are different methods of pain medicine delivery:

• A "basal rate" is a small amount of pain medicine running into the catheter tube all the time.
  
  
• Caregivers may put medicine into the catheter when you tell them that you have pain.
  
  
• You may be given a button you can push to release medicine into the catheter. This is called patient controlled analgesia or "PCA." A PCA machine is set up so that you are not able to give yourself too much medicine.
  
  
• You may have both a basal rate, and a PCA for when you need more pain medicine.

Who should press the PCA button? Current guidelines state that only the patient should press the PCA button for pain relief. If you think that someone else should press the button for you, talk to your caregiver. Tell your caregiver if you are still uncomfortable a few minutes after pushing the button. Caregivers can usually tell by your heartbeat and breathing if you need more medicine. Caregivers can also tell if you are getting too much pain medicine. Ask your caregiver for more information about patient controlled analgesia.

How is an epidural different from an injection?

• With an epidural, small amounts of pain medicine may be given continuously or only as needed. The medicine works faster than an injection. You may still have pain, but it should be an amount that is manageable for you.
  
  
• With an injection (hypo or shot into a muscle), you may have to tell your caregiver that your pain is getting worse. You may then have to wait for your caregiver to get the medicine ready. With an injection, you may get a larger amount of pain medicine at one time. Your pain may return before you can get another shot, since time (usually hours) must pass between injections.

Will taking pain medicine slow my recovery? No. Pain medicine is needed and important after an injury or surgery, and during some illnesses. Using an epidural for pain control allows you to rest comfortably. Being comfortable helps you to breathe more deeply and may help you heal faster.

Are there risks with an epidural? All medicine has some risks and side effects. With an epidural you may get an infection or have bleeding in the epidural space. The medicine may not completely control your pain. The medicine could numb your muscles so much that you can not move or walk. The medicine could make your blood pressure drop too low. It may also make you breathe too slowly or not often enough. Your skin may be itchy or you may have trouble urinating.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your pain and how an epidural can be used to treat it. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

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