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Epidural Catheter
Epidural Catheter
The epidural catheter allows for administration of a mixture of local anesthetics and narcotics to provide pain relief during surgery. Unlike analgesic injections, which are given on demand and cannot be easily adjusted, the epidural provides continuous medication with the ability to control the dosage. The procedure can be performed by an anesthesiologist or certified registered nurse anesthetist who is trained in neuraxial anesthesia. Physicians from other specialties who have appropriate training and experience in the field may also perform the procedure within their scope of practice.
The patient will be positioned in either the supine or reclining position. A sterile insertion site will be cleaned and the catheter inserted into the epidural space. A sterile sponge is placed over the tip of the catheter and an occlusive clear dressing (eg, Tegaderm) is applied to the insertion site. The anesthesia team will monitor the insertion site for signs of leaking fluid and proper function of the catheter.
Once the epidural catheter is in place, it will be injected with medication and checked to ensure the mixture is working properly by observing pain relief and/or development of numbness. The numbness or pain relief should be evident within minutes after injection. Depending on your needs, your catheter may be left in place for several days or more.
Anesthesia and Pain Management physicians are available to help you determine the best analgesics for your surgery and recovery. Please let your doctor know if you are having difficulty obtaining the analgesics that you need.
If you have an epidural catheter that is not providing adequate pain relief, the physician will perform a procedure called an epidural blood test to check for the presence of drugs that inhibit or interfere with analgesic effects, such as a local anesthetic or opioid. Alternatively, the physician can use a spinal wave form analysis to evaluate if the catheter is located in the epidural space. However, this technique is time consuming and can be influenced by medications the patient is taking.
Epidural catheters have been designed to influence the quality of analgesia, decrease the incidence of complications, and allow for more extensive medication distribution. Specific catheter features, including the material used, tip design, and orifice number and placement, have been associated with distinct outcomes.
It is important to have a clear understanding of the anatomy and physiology of the epidural space in order to optimize the placement of an epidural catheter. Various methods are used to identify the location of the epidural space, which include a lumbar spine radiograph, a low-dose narcotic challenge, and a test dose of local anesthetic and epinephrine. Despite the availability of these tests, many patients experience inadequate analgesia during labor and delivery. The most common reasons for this include unsatisfactory epidural analgesia and a failed intrathecal administration of medication.
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