Introduction
Epidural anesthesia anesthetizes the lower abdomen to the legs. Sometimes it is used to be re-delivered continuously in lengthy surgical procedures to keep on the effect of anesthesia. Continuous epidural anesthesia is used in combination with spinal anesthesia, in the cases of labor and delivery of the child. They are used in cesarean sections mostly to overcome the pain. This topic explains the uses of continuous epidural anesthesia in surgery, its purpose, risks, and contraindications.
What Is Epidural Anesthesia?
Epidural anesthesia is anesthesia delivered in epidural space present in the backbone. It helps anesthetizes the lower abdomen area to the legs. It is mostly used in cesarean sections to deliver the baby through surgical procedures instead going for the vaginal path. Epidural anesthesia is provided in the form of injections. For better outcomes, epidural anesthesia is sometimes used in combination with spinal anesthesia (anesthesia delivered in the spinal sac).
What Is a Continuous Epidural Infusion?
Continuous epidural infusion or anesthesia infuses an anesthetic drug to relieve the patient from the pain. It uses low doses of opioids along with anesthesia medication. The drug is infused by a catheter already placed on the back of the patient. The doctor keeps the catheter for two to four days for regular drug infusion.
What Is the Purpose of Continuous Epidural Infusion?
The purpose of continuous epidural infusion is to relieve the pain after the surgery. It is placed for the first few days of recovery. The anesthesia drug used blocks the nerve signals going to the brain. It can be given continuously for three to four days after the surgery as a postoperative analgesia medicine. It has better results than orally taken pain relief medicines.
How Does the Continuous Epidural Infusion Work?
Nerves send the pain sensation to the brain from the spinal area. Epidural infusion of anesthesia blocks the nerve signals traveling up to the spinal cords. Further, the signals are inhibited from reaching the brain. And this blocking makes the patient stop feeling pain. The primary function of blocking nerve pain is conquered.
When Is Continuous Epidural Infusion Required?
Continuous epidural infusion is required in the following cases :
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Obstetric Surgery - Obstetrics is a branch that deals with the pregnancy, delivery, and post-delivery period. Cesarean surgery comes under obstetrics. Cesarean surgery for labor and child delivery surgery provides rapid onset and long pain relief with spinal anesthesia and continuous infusion of epidural anesthesia.
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Non-Obstetric Surgery - The spinal and epidural combination is used in many other fields of surgery, including orthopedic, urological, vascular, and general surgeries.
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Surgeries that are performed under combined general and epidural anesthesia.
How Is Continuous Epidural Infusion Performed?
The procedure can be performed by different healthcare professionals. A doctor can place the catheter during the surgery. An anesthesiologist (one who is a specialist in anesthesia) can put it on the spine. Infusion for two to three days can be given by a surgeon under whom surgery is performed or by an anesthesiologist, or even a trained nurse can perform it under a doctor's supervision.
Continuous epidural infusion is performed as:
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The patient is relaxed before surgery.
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Soon after, the patient is made to sit or lie down on the belly.
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The area on the back where the epidural catheter needs to place is made to clean with the antiseptic solution.
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Spinal anesthesia or general anesthesia is delivered to the patient.
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The epidural needle with the catheter is taken and placed at the spine.
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Sometimes, an epidural catheter is placed after the surgery.
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The needle is removed, and the catheter remains for further infusion.
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The catheter is placed.
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The catheter can perform a regular infusion of anesthesia post-surgery.
What Can Happen After the Epidural Catheter Is Placed?
After the placement of the epidural catheter, the infusion of anesthetic medicine is given. The patient can expect symptoms such as:
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Difficulty in breathing.
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Pain on the insertion site.
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Less ability to move legs.
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Confused.
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Dizziness.
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Itchiness on skin.
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Constipated.
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The patient can feel he is still in pain.
The patient is not allowed to go home with an attached epidural catheter. The patient requires medical attention after the surgery. So, the doctor uses the method of continuous epidural infusion to control pain for two to four days for better patient recovery. The epidural catheter is removed before discharging the patient.
What Are the Risks Related to Continuous Epidural Infusion?
The risks related to continuous epidural infusion are:
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Infection.
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Bleeding.
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A sudden drop in blood pressure.
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Severe headache.
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Dizziness.
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Allergic reaction.
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Breathing problems.
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Seizures.
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Spinal cord damage.
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Nerve injury.
What Are the Contraindications to Continuous Epidural Infusion?
Contraindications to continuous epidural infusions are:
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Allergy to anesthetic drugs.
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Localized infection in the area of an epidural catheter.
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Any previous spinal cord injury present, like spinal stenosis (narrowing of the spinal cord).
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When the patient refuses to go for it.
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If the patient is under anticoagulants (medicine preventing blood clots).
What Is the Medicine or Drug Used in Continuous Epidural Infusion?
The doctors use local anesthetics for continuous epidural anesthesia. Bupivacaine or Ropivacaine, along with Morphine, is used as an anesthetic drug for continuous infusion of epidural anesthesia. The drugs can vary in cases of child patients.
Can Continuous Infusion of Epidural Anesthesia Be Performed in Children?
Yes, continuous epidural infusion can be used in children. Both the children as well as neonates can take benefit from continuous infusions. Continuous epidural infusions have increased the recovery rates of child patients. In addition, the continuous epidural infusion has decreased the drug's side effects like infection and toxicity. It is entirely safe for use in children.
Conclusion
Continuous epidural infusions are used in post-surgical cases to relieve the patient from pain. The doctor uses a continuous infusion of epidural anesthesia for better patient recovery. The patient is admitted to the hospital till the epidural infusion is delivered. The continuous infusion is given by the epidural catheter installed at the back of the patient to provide the anesthetic drug when required. The doctor installs the catheter for two to four days and removes it for discharging the patient.
