Lecture 3.2 - PCA Flashcards
What are indications for epiudural analgesia?
Postoperative analgesia, management of post traumatic pain, provide intra-operative anesthesia and analgesia, manage pain associated with obstetrical cases.
What are some contraindications for epidural?
–> Systemic infection or infection at site
–> Tumour at site
–> coagulopathy
–> Neurological (CNS diseases)
What are some advantages of epidural analgesia?
–> Rapid, site specific prolonged pain relief
–> Lower narcotic doses
–> Fewer side effects than opioids
–> Allows continuous delivery of analgesia
What medications are given epidurally?
Mixture of narcotic and local anesthetic (nerve block) for synergistic effects
Common local anesthetics include bupivacaine, ropivacaine
Common narcotics include epimorph, fentanyl, hydromorphone
What are some side effects of epidural analgesia?
HypoTN, urinary retention, pruritis, motor and sensory loss, brady
How often should VSs be done w a pt on epidural analgesia? What about motor and sensory scales? What should always be available?
q5min x 4, then q1h x 4, then q2h x 24hr
Motor and sensory scales q4h and prn
Ensure NARCAN and o2 are available. Only preservative free medications can be used.
What are potential complications of epidural analgesia?
–> Leaks, disconnections, dislodgement
–> Cath migration
–> Dural puncture
–> Epidural hematoma and infection (both rare)
Where is the catheter for spinal analgesia placed? What meds are used?
Cath is placed in intrathecal/subarachnoid space
Opioid is usually morphine or fentanyl
Used with local anesthetic but at a fraction of the dose of what is used with epidurals.
What are the indications are spinal analgesia?
ABD surgeries, total joint replacements, c-sections
What is the motor scale?
1 - normal
2 - can flex knees and move feet
3 - unable to flex knees, can move feet
4 - unable to flex knees or move feet
5 - unable to move arms or breathe deeply.
