Epidural Pain Control For Children

GENERAL INFORMATION:

What is it? Epidural pain control means putting pain medicine into the space around the spinal cord in your child's 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 from many different conditions. It can help decrease acute (short-term) pain, like after surgery or an accident. It 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 child's back in the operating room, or in your child's bed in the hospital. It may also be inserted in your child's caregiver's office. Your child will lie curled up on his side or in a sitting position on the side of the bed. The skin on your child's back is washed and then numbed with medicine to decrease feeling and pain. A needle is put in between 2 bones in his 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 child's back and shoulder.
  
  
• Your child will go to the operating room to have a permanent (long-term) catheter placed in his back. Your child may be given medicine to sleep while the catheter is put in. The permanent epidural catheter comes out of a small incision (cut) on the side of your child's body or near the belly button. The area where the catheter comes out is called the "exit site". Your child will also have small cuts with stitches on his back and on his side. These cuts are where the permanent catheter was put under your child's skin. After having an epidural catheter put in, your child may still lie on his back to rest or sleep.

How does an epidural work? A small pump attached to a syringe is filled with pain medicine. This is attached to your child's epidural catheter. There are different methods of medicine delivery:

• A "basal rate" is a small amount of pain medicine running through the catheter into the epidural space all the time.
  
  
• Caregivers may put medicine into the catheter when your child tells them that the pain is returning. You may also tell caregivers that you think your child is in pain.
  
  
• Your child may be given a button he can push to release medicine into the catheter. This is called patient controlled analgesia or "PCA." A PCA machine is set up so that your child is not able to give himself too much 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 your child, talk to your child's caregiver. Call your child's caregiver if you feel your child is still uncomfortable a few minutes after he has pressed the button. Caregivers can tell if your child is having pain by checking your child's vital signs (heartbeat and breathing). They can also see if your child is getting too much pain medicine. Caregivers will make sure your child gets the right amount of pain medicine. Ask your caregiver if you need more information about patient controlled analgesia.

How do I know if my child's pain is being controlled? Young children and babies may not be able to tell you if they are in pain. There is no one way to know that your child is in pain. A child may act in some of the following ways that help you to know if he hurts:

• Your child may be restless and unable to sleep. He may fall asleep, but wake up often.
  
  
• If your child is a baby or a toddler, he may not be wet, dirty, hungry or tired, but will cry a lot.
  
  
• Your child may want to be held all of the time, or not held at all.
  
  
• This may work for older children: Draw a "smiley face" on a piece of paper. The picture should be simple. A pencil drawn circle with two dots for eyes, a dot for the nose, and a half circle for a smile works well. Draw 3 more "faces" with dots for eyes and a nose and change the smile to a straight line in one circle, a frown in the next, and the last one with a frown and tears. Ask your child to point to the one that most looks like he feels. If the child is acting normally and points to the face with tears and a frown, believe the picture. Children often behave normally even when they hurt a lot.

How is an epidural different from an injection?

• With an epidural, small amounts of pain medicine can be given continuously or as needed. The medicine works faster than an injection. Your child may still have pain, but it should be kept at a low level. The goal is to not have pain stopping him from doing things he would normally do.
  
  
• With an injection (hypo or shot into a muscle), you may have to tell your child's caregiver that your child's pain is getting worse. Your child may have to wait for the medicine. With an injection, your child may get a larger amount of pain medicine at one time. Your child's pain may return before he can get another shot, since time (usually hours) must pass between injections. Your child may fear needles, and not tell you he is having pain to avoid getting a shot.

Will taking pain medicine slow my child's recovery? No. Pain medicine is needed and important after an injury or surgery, and during some illnesses. Being comfortable helps your child to breathe more deeply and may help your child heal faster.

CARE AGREEMENT:

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

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