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Epidural Pain Control For Children


What is epidural pain control?

Epidural pain control is when pain medicine is put into the space around your child's spinal cord (epidural space). An epidural is a way for your child to get pain medicine without repeated injections. An epidural can help decrease acute (short-term) pain from surgery or an accident. It can also be used to decrease long-term pain, like cancer pain.

How is the epidural catheter put in?

  • A temporary catheter can be put in your child's back in the operating room, a hospital bed, or the caregiver's office. Your child will be asked to lay on his side or sit on the side of the bed. The skin on his back will be numbed with medicine to decrease feeling and pain. A needle is put in between 2 bones in his back. A catheter (thin plastic tube) is threaded through the needle. The medicine is put into the catheter. With a temporary epidural, the catheter is taped to his back and shoulder.
  • Your child will go to the operating room to have a permanent catheter placed in his back. Your child may be given medicine to make him sleep during the procedure. The permanent epidural catheter comes out of a small incision on your child's side or near his belly button. This is called the exit site. He will also have small incisions with stitches in his back and side. This is where the catheter was put under his skin.

How does an epidural work?

A small pump attached to a syringe filled with pain medicine is hooked up to your child's catheter. There are different methods of pain medicine delivery:

  • A basal rate is a small amount of pain medicine that goes into the catheter tube all the time.
  • Caregivers may put medicine into the catheter when your child tells them he is in pain. You may also tell caregivers if you think your child is in pain.
  • Your child may have patient-controlled analgesia (PCA), which is a button he can push to release medicine into the catheter.

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. Contact your child's caregiver if you feel your child is still uncomfortable after he has pressed the button. A PCA machine is set up so that your child is not able to give himself too much medicine. Ask your caregiver for more information about PCA

How do I know if my child is in pain?

Ask your child if he is in pain. If your child is older, draw a smiley face with a half circle for a smile. Draw 3 more faces and change the smile to a straight line in one circle, a frown in the next, and a frown with tears in the last one. Ask your child to point to the one that most looks like how he feels. If you have a baby or small child, you may need to watch for signs of pain. You may notice the following behaviors:

  • Restlessness: Your child may not be able to sleep, or he may fall asleep but wake up often.
  • Cries a lot: If your child is a baby or a toddler, he may cry even though he does not have a wet or dirty diaper or is not hungry or tired.
  • Fussiness: Your child may want to be held all of the time or not held at all.

What are the risks of an epidural for pain control?

An epidural may cause an infection or bleeding in the epidural space. The medicine may not completely control your child's pain. The medicine may numb his muscles so much that he cannot move or walk. The medicine could decrease your child's blood pressure too much. It may make him breathe too slowly or not often enough. Your child's skin may be itchy or he may have trouble urinating.

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • You feel your child's pain is not being controlled by the medicine.
  • The skin around your child's incisions is red or swollen, or the incision has pus draining from it.
  • Your child has trouble moving, urinating, or having a bowel movement.
  • Your child has a new problem controlling his bladder or bowels.
  • Your child suddenly loses feeling around the anus or genitals.
  • You have questions about your child's condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • Your child has trouble breathing, is dizzy, or has itchy skin or a rash.
  • Your child is weak, achy, has the chills, or 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 pupils stay small even in a darkened room.
  • Your child has a stiff neck or trouble thinking clearly.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. 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.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.