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Epidural Post-Operative Pain Relief

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Increasingly this is common practice throughout the UK.

It is particularly used in children and the elderly to enhance the level of pain relief.

Patient Controlled Anaesthesia allows the patient to ensure that he/she remains comfortable.

Anaesthetists may prescribe a PCA machine for several days or offer the option of an epidural block.

In an epidural block, a needle is placed into the epidural space and a small catheter is then threaded through the needle into the space; the needle is then removed.

Local anaesthetic solution or a combination of local anaesthetic mixed with a low dose of narcotics can then be injected through the catheter or a continuous infusion can be maintained for several days.

In children, the epidural catheter tends to be introduced whilst the patient is still under general anaesthetic to avoid pain and distress; however, there are risks attached to this, particularly that the patient is unable to protest should the procedure cause inadvertent misplacement of the needle (damaging nerve roots for example).

A paper in 2000 ([i]) described 10 cases of infection associated with the use of epidural catheters for post-operative pain relief between 1997 and 1998.

A case control study showed that the infections were commoner in the summer months and associated with analgesia infused by syringes rather than pumps.

[i] Dawson SJ, Small H, Logan MN, Geringer S. Commun Dis Public Health 2000 Dec; 3(4):300-2 Case control study of epidural catheter infections in a district general hospital.