If English is not your first language and you need help, please contact the Interpretation and Translation Service Jeśli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy, skontaktuj się z działem tłumaczeń ustnych i pisemnych

تمدخ ہمجرت روا ینامجرت مرک هارب ، وت ےہ ترورض یک ددم وک پآ روا ےہ ںیہن نابز یلہپ یک پآ یزیرگنا رگاںیرک ہطبار ےس

Dacă engleza nu este prima ta limbă și ai nevoie de ajutor, te rugăm să contactezi Serviciul de interpretare și traducere ইংরাজী যিদ আপনার .থম ভাষা না হয় এবং আপনার সাহােয9র .েয়াজন হয় তেব অন=ুহ কের ?দাভাষী এবং অনবুাদ পিরেষবা@েত ?যাগােযাগ কBন

ةیریرحتلاو ةیوفشلا ةمجرتلا ةمدخب لاصتالا ىجریف ، ةدعاسم ىلإ جاتحتو ىلوألا كتغل يھ ةیزیلجنإلا نكت مل اذإ

: 0161 627 8770

: interpretation@pat.nhs.uk To improve our care environment for Patients, Visitors and Staff, Northern Care Alliance NHS Group is Smoke Free including buildings, grounds & car parks. For advice on stopping smoking contact the Specialist Stop Smoking Service on 01706 517 522 For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service The Northern Care Alliance NHS Group (NCA) is one of the largest NHS organisations in the country bringing together two NHS Trusts, Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust. The NCA employs over 19,000 staff and provides a range of hospital and community healthcare services to more than 1 million people across Salford, Oldham, Bury, Rochdale, North Manchester and surrounding areas. Our Care Organisations are responsible for delivering safe, high quality and reliable care to the local communities they serve.

The Northern Care Alliance NHS Group (NCA) is one of the largest NHS organisations in the country, employing 17,000 staff and providing a range of hospital and community healthcare services to around 1 million people across Salford, Oldham, Bury, Rochdale and surrounding areas. Our Care Organisations are responsible for providing our services, delivering safe, high quality and reliable care to the local communities they serve.

The NCA brings together Salford Royal NHS Foundation Trust and the hospitals and community services of The Royal Oldham Hospital, Fairfield General Hospital in Bury, and Rochdale Infirmary (currently part of The Pennine Acute Hospitals NHS Trust).

www.pat.nhs.ukwww.northerncarealliance.nhs.uk

www.facebook.com/NorthernCareAllianceNHSGroup

www.linkedin.com/company/northern-care-alliance-nhs-group

Northern Care Alliance NHS Group (NCA) @NCAlliance_NHS

Epidurals for painrelief after surgeryAn information guide

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Epidurals for pain relief after surgery

Introduction

This leaflet explains what to expect if you choose to have anepidural placed for pain relief during and after your operation. Ithas been written by patients, patient representatives andanaesthetists, working together.

What is an epidural?

An epidural is used for giving pain relief. It can be used duringsurgery to supplement a general anaesthetic and continued afterthe operation for pain control.

The nerves from your spine to your lower body pass through anarea in your back close to your spine, called the "epidural space".

To establish an epidural an anaesthetist injects local anaestheticsthrough a fine plastic tube called an epidural catheter into thisepidural space. As a result, the nerve messages are blocked. Thiscauses pain relief, which varies in extent according to the amountof local anaesthetic injected. It may also cause some numbness aswell as pain relief.

An epidural pump allows local anaesthetic to be givencontinuously. Other pain relieving drugs can also be added in smallquantities. The amounts of drugs given are carefully controlled.

When the epidural is stopped, full feeling will return.

Epidurals may be used during and/or after surgery for pain relief.

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How is an epidural done?

Epidurals can be put in:

• When you are conscious. This is the usual and safest option.• When you are under sedation (when you have been given a

drug which will make you drowsy and relaxed, but stillconscious)

• or during a general anaesthetic. However the risks of nervedamage (see below) are higher if an epidural is inserted whilstyou are asleep.

These choices can be discussed further with your anaesthetist.

• 1. A needle will be used to put a thin plastic tube (a ‘cannula’)into a vein in your hand or arm for giving fluids (a ‘drip’).

• 2. If you are conscious, you will be asked to sit up or lie on yourside, bending forwards to curve your back. It is important tokeep still while the epidural is put in.

• 3. Local anaesthetic is injected into a small area of the skin ofyour back.

• 4. A special epidural needle is pushed through this numb areaand a thin plastic catheter is passed through the needle intoyour epidural space. The needle is then removed, leaving onlythe catheter in your back.

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What will I feel?

The local anaesthetic stings briefly, but usually allows an almostpainless procedure.

It is common to feel slight discomfort in your back as the catheter isinserted.

Occasionally, an electric shock-like sensation or pain occurs duringneedle or catheter insertion. If this happens, please tell youranaesthetist immediately.

A sensation of warmth and numbness gradually develops, like thesensation after a dental anaesthetic injection. You may still be ableto feel touch, pressure and movement. Your legs feel heavy anddifficult to move.

You may only notice these effects for the first time when yourecover consciousness after the operation, particularly if yourepidural was put in when you were asleep for your operation.Overall, most people do not find these sensations to be unpleasant,just a bit strange.

The weakness of the leg muscles or numbness may persist after youleave the theatre recovery room. This will wear off once theepidural stops. If you feel that this is a problem and you don’t likethe sensation then tell the nurses immediately and they will contacta member of the pain team.

Please don’t attempt to get out of bed on your own whilst theepidural is running – you will probably fall.

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How do the nurses look after me on the ward with an epidural?

• At regular intervals, the nurses will take your pulse and bloodpressure and ask you about your pain and how you are feeling.

• They may adjust the rate at which epidural pump runs and willtreat any side effects which may occur.

• They will check that the pump is functioning correctly. Theywill encourage you to move, eat and drink, according to thesurgeon’s instructions.

• The Pain Relief Team doctors and nurses may also visit you, tocheck your epidural is working properly.

When will the epidural be stopped?

• The epidural will be stopped when you no longer require it forpain relief.

• A few hours after the pump is stopped, the epidural tubing willbe removed, as long as you are still comfortable.

• The epidural catheter will be removed if it is not workingproperly. Another epidural catheter may be re-inserted ifnecessary. However this depends upon the anaesthetist andwhether you wish to have the procedure repeated.

Can anyone have an epidural?

No. An epidural may not always be possible if the risk ofcomplications are too high.

The anaesthetist will ask you if:

• You are taking blood thinning drugs, such as warfarin• You have a blood clotting abnormality• You have an allergy to local anaesthetics• You have severe arthritis or deformity of the spine• You have an infection in your back

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What are the benefits?

• Better pain relief than other methods, particularly when youmove.

• Reduced complications of major surgery. These may includenausea/vomiting, leg or lung blood clots, chest infections,blood transfusions and delayed bowel function.

• You should need less alternative strong pain relievingmedicine. This means that your breathing will be better, thereshould be less nausea and vomiting and you are likely to bemore alert.

• Quicker return to eating, drinking and full movement, possiblywith a shorter stay in hospital compared to other methods ofpain relief.

What are the side effects and complications?

All the side effects and complications described can occur withoutan epidural.

Side effects are common, are often minor and are usually easy totreat. Serious complications are fortunately rare.

The risk of complications should be balanced against the benefitsand compared with alternative methods of pain relief. Youranaesthetist can help you do this.

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Very common side effects and complications

Inability to pass urine - The epidural affects the nerves that supplythe bladder, so a catheter (‘tube’) will usually have to be inserted todrain it. This is often necessary anyway after major surgery to checkkidney function. With an epidural, it is a painless procedure.

Bladder function returns to normal when the epidural wears off.

Low blood pressure - The local anaesthetic affects the nerves goingto your blood vessels, so blood pressure always drops a little. Fluidsand/or drugs can be put into your drip to treat this. If you takemedication to control your blood pressure these may be omittedwhilst your epidural is running because of this effect. Low bloodpressure is common after surgery, even without an epidural.

Itching - This can occur as a side effect of morphine-like drugs usedin combination with local anaesthetic. It is easily treated with anti-allergy drugs.

Feeling sick and vomiting - These can be treated with anti-sicknessdrugs. These problems are less frequent with an epidural than withmost other methods of pain relief.

Backache - This is common after surgery, with or without anepidural and is often caused by lying on a firm flat operating table.

Inadequate pain relief - It may be impossible to place the epiduralcatheter, the local anaesthetic may not spread adequately to coverthe whole surgical area, or the catheter can fall out. Overall,epidurals usually provide better pain relief than other techniques.Other methods of pain relief are available if the epidural fails.

You will not be left in unmanageable pain.

Headaches - Minor headaches are common after surgery, with orwithout an epidural.

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Occasionally a severe headache occurs after an epidural becausethe lining of the fluid filled space surrounding the spinal cord hasbeen inadvertently punctured (a ‘dural tap’). The fluid leaks outand reduces the pressure of the fluid which surrounds the brain,particularly when you sit up. Occasionally it may be necessary toinject a small amount of your own blood into your epidural space.This is called an ‘epidural blood patch’. The blood clots and plugsthe hole in the epidural lining. It is almost always immediatelyeffective. The procedure is otherwise the same as for a normalepidural.

Slow breathing - Some drugs used in the epidural can cause slowbreathing and/or drowsiness requiring treatment. The nursesmonitor for this continually whilst your epidural infusion isrunning.

Catheter infection - The epidural catheter can become infectedand may have to be removed. Antibiotics may be necessary. It is veryrare for the infection to spread any further than the insertion site inthe skin.

Rare or very rare complications

Other complications, such as convulsions (fits), breathing difficultyand temporary nerve damage are rare whilst permanent disablingnerve damage, epidural abscess, epidural haematoma (blood clot)and cardiac arrest (stopping of the heart) are very rare indeed.

In comparison, you are more likely to die from an accident on theroads or in your own home every year than suffer permanentdamage from an epidural. These risks can be discussed further withyour anaesthetist and more detailed information is available.

(All risks quoted are approximate and assume best practice).

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What if I decide not to have an epidural?

It is your choice. You do not have to have an epidural.

There are several alternative methods of pain relief with morphinethat work well; injections given by the nurses or by a pump into avein which you control by pressing a button (Patient ControlledAnalgesia, ‘PCA’).

There are other ways in which local anaesthetics can be given.

You may be able to take pain relieving drugs by mouth or assuppositories.

Every effort will always be made to ensure your comfort.

How do I ask further questions?

Ask the nursing staff or your anaesthetist.

Future sources of information about epidural anaesthesia availablefrom the website. www.youranaesthetic.info.

Most hospitals have a team of nurses and anaesthetists whospecialise in pain relief after surgery. You can ask to see a memberof the pain team at any time. They may have leaflets availableabout pain relief.

Questions you may like to ask your anaesthetist

• Who will give my anaesthetic?• Do I have to have this type of pain relief?• Have you often used this type of pain relief?• What are the risks of this type of pain relief?• Do I have any special risks?• How will I feel afterwards?

For more information and help please contact the anaestheticdepartment in your local hospital.

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Booklets produced in the same series by the Royal College ofAnaesthetists and Association of Anaesthetists are available atwww.youranaesthetic.info.

They include:

Epidurals for pain relief after surgery

Your spinal anaesthetic

Headache after a spinal or epidural injection

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Notes:

If English is not your first language and you need help, please contact the Interpretation and Translation Service Jeśli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy, skontaktuj się z działem tłumaczeń ustnych i pisemnych

تمدخ ہمجرت روا ینامجرت مرک هارب ، وت ےہ ترورض یک ددم وک پآ روا ےہ ںیہن نابز یلہپ یک پآ یزیرگنا رگاںیرک ہطبار ےس

Dacă engleza nu este prima ta limbă și ai nevoie de ajutor, te rugăm să contactezi Serviciul de interpretare și traducere ইংরাজী যিদ আপনার .থম ভাষা না হয় এবং আপনার সাহােয9র .েয়াজন হয় তেব অন=ুহ কের ?দাভাষী এবং অনবুাদ পিরেষবা@েত ?যাগােযাগ কBন

ةیریرحتلاو ةیوفشلا ةمجرتلا ةمدخب لاصتالا ىجریف ، ةدعاسم ىلإ جاتحتو ىلوألا كتغل يھ ةیزیلجنإلا نكت مل اذإ

: 0161 627 8770

: interpretation@pat.nhs.uk To improve our care environment for Patients, Visitors and Staff, Northern Care Alliance NHS Group is Smoke Free including buildings, grounds & car parks. For advice on stopping smoking contact the Specialist Stop Smoking Service on 01706 517 522 For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service The Northern Care Alliance NHS Group (NCA) is one of the largest NHS organisations in the country bringing together two NHS Trusts, Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust. The NCA employs over 19,000 staff and provides a range of hospital and community healthcare services to more than 1 million people across Salford, Oldham, Bury, Rochdale, North Manchester and surrounding areas. Our Care Organisations are responsible for delivering safe, high quality and reliable care to the local communities they serve.

The Northern Care Alliance NHS Group (NCA) is one of the largest NHS organisations in the country, employing 17,000 staff and providing a range of hospital and community healthcare services to around 1 million people across Salford, Oldham, Bury, Rochdale and surrounding areas. Our Care Organisations are responsible for providing our services, delivering safe, high quality and reliable care to the local communities they serve.

The NCA brings together Salford Royal NHS Foundation Trust and the hospitals and community services of The Royal Oldham Hospital, Fairfield General Hospital in Bury, and Rochdale Infirmary (currently part of The Pennine Acute Hospitals NHS Trust).

www.pat.nhs.ukwww.northerncarealliance.nhs.uk

www.facebook.com/NorthernCareAllianceNHSGroup

www.linkedin.com/company/northern-care-alliance-nhs-group

Northern Care Alliance NHS Group (NCA) @NCAlliance_NHS

Date of publication: February 2006Date of review: March 2019Date of next review: March 2021Ref: PI_DS_224© The Northern Care Alliance NHS Group