Epidural Pain Control For Children

WHAT YOU SHOULD KNOW:

• Epidural (eh-pih-DUR-ull) pain control means putting pain medicine through a catheter (very thin plastic tube) into your child's epidural space. The epidural space is the area around the spinal cord in your child's back. A small pump attached to a syringe filled with pain medicine is hooked up to the catheter. A "basal rate" is a small amount of pain medicine running into the epidural space all the time. The medicine may also be given on an as-needed basis, either by your child's caregiver or your child. Caregivers will work with your child to make sure your child gets enough medicine to control pain.
  
  
• Using an epidural for pain control is a way to use pain medicine without the need for repeated injections (shots). Epidurals have been used to decrease the pain of childbirth for many years. Now epidurals may be used to treat pain from many other conditions. Epidurals can can help decrease acute (short-term) pain, like pain after surgery or accidents. They can also help decrease chronic (long term) pain like cancer pain.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of the medicines your child takes, the amount, and when and why your child takes them. Bring the list of your child's medicines or the pill bottles when you take your child to see caregivers. Learn why your child takes each medicine. Ask your child's caregiver for information about your child's medicines. Do not give your child any medicine without first talking to caregivers
  
  
• Always give your child medicine as directed by caregivers. Call your child's caregiver if you think the medicine is not helping or if you think your child is having side effects. Do not stop giving your child any medicine until you talk to your child's caregiver. If your child is taking antibiotics (an-ti-bi-AH-tiks), give them to your child until they are all gone even if your child feels better.
  
  
• Caregivers will help you and your family learn more about the epidural catheter and the medicine your child is taking. Ask your caregiver to show you and your child how to get this medicine and how to care for the catheter. Your child should take enough medicine to feel comfortable. Do not worry about your child becoming addicted to the medicine.
  
  
• Pain medicine will make your child drowsy. Do not let your child do activities like play on playground equipment or ride a bike while taking medicine for pain.

How do I care for the exit site?

The exit site should be kept clean and covered. Caregivers may teach you how to take care of your child's exit site. If caregivers tell you to, change the bandage every day for the first 7 days. After that, change it every second day. Change the bandage any time it becomes loose, wet, or dirty.

How do I change the exit site bandage?

Gather the following things to change your child's bandage:

• 4 sterile cotton swabs.
  
  
• Betadine™ solution.
  
  
• 2 sterile pre-cut gauze pads.
  
  
• 1 sterile 4x4 gauze pad.
  
  
• A roll of 1 inch wide tape.

• Wash your hands very well with soap and water, and dry them completely.
  
  
• Take the old bandage off. Do not pull on the catheter.
  
  
• Look at the exit site. Tell your child's caregiver if you see redness, swelling, drainage, or any other changes.
  
  
• Clean the skin around the catheter at the exit site with one of the cotton swabs dipped in the Betadine™ solution. Clean the skin in a circle, starting at the catheter and moving out about 3 inches. Repeat this step with another cotton swab. Finally, repeat this step for a third time with the third cotton swab.
  
  
• Dip the fourth (last) cotton swab into the Betadine™ solution and wipe the catheter gently. Start from the exit site and go up to the filter.
  
  
• Cover the exit site with a pre-cut sterile gauze pad. Gently put the catheter through the pre-cut slit in the pad. Do not touch the side of the pad that will be touching your child's skin.
  
  
• Turn the second pre-cut gauze pad so the slit is turned in the opposite direction of the first pad. Put it over the exit site, gently pulling the catheter through the slit.
  
  
• Cover the area with a 4x4 gauze pad.
  
  
• Cut the 1 inch wide tape into strips to keep the 4x4 in place.
  
  
• Loop the catheter over the dressing and tape the catheter in place.

How do I change the filter on the machine?

Your child's caregivers may show you how to change the filter and tubing on the machine. Follow these steps:

• Wash your hands very well with soap and water. Dry them completely.
  
  
• Gather the following items:
  
  
  • Sterile filter.
    
    
  • 1 sterile cotton swab.
    
    
  • Betadine™ solution.
    
    
  • A roll of 1 inch wide tape.
  
  
• Open the filter and injection cap package. Remove the pre-attached cap from the new filter. Do not touch the end of the filter.
  
  
• Hook the new filter to new tubing on the new medicine container and let the medicine flow through the filter.
  
  
• Remove the tape from the old filter.
  
  
• Wipe the area where the filter is attached to the catheter with the cotton swab dipped in Betadine™. Allow it to air dry.
  
  
• Remove the old filter. Ask your child's caregiver how or where to throw it away. Make sure to keep it away from children and pets.
  
  
• Hook the new filter to the catheter.
  
  
• Tape the area where the filter hooks to the catheter to keep it from coming undone.

When can my child take a shower?

If your child is old enough to shower, he may shower 1 week after the catheter has been placed. Cover the catheter and exit site with a waterproof covering such as plastic food wrap. Tape around the edges of the wrap to keep water out. Put a clean bandage on the exit site after showering.

CONTACT A CAREGIVER IF:

• You feel your child's pain is not being controlled by the medicine.
  
  
• The skin around your child's exit site, side or back incisions (cuts) is red, swollen, or has pus coming from any of the incisions (cuts). This may mean your child has an infection (in-FECK-shun).
  
  
• Your child has trouble breathing, is dizzy, has itchy skin or a rash. The medicine may be causing these symptoms. Your child may be allergic (uh-LER-juk) to the medicine.
  
  
• Your child has trouble moving, urinating, or having a BM. These may be side effects of the medicine.
  
  
• Your child has a new problem moving his legs.
  
  
• Your child has a new problem controlling his bladder or bowels.
  
  
• Your child suddenly loses feeling around the anus (A-nihs) (rear-end) or genitals (JEN-ih-tulls).

SEEK CARE IMMEDIATELY IF:

• Your child has shaking chills, feels weak or achy, or has a temperature over 100.4° F (38° C).
  
  
• Your child does not wake up easily, has slurred speech, or sleeps a lot.
  
  
• Your child's pupil, the black center part of the eye, stays small even in a darkened room.
  
  
• Your child has a stiff neck or seems to have trouble thinking clearly.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.