Opioids during epidural anesthesia
Peridural or epidural anaesthesia is usually not performed as a single-shot procedure (only a single injection). Much more frequently, a thin plastic catheter is positioned and fixed after puncture, through which drugs can be administered even after the operation. Patients may thus have the option of receiving a so-called patient-controlled epidural anaesthesia (PCEA).
This is a “pain pump”, where the individual doses, the total dose and the blocking times are fixed. The patient can re-dose as required. In general, opioids (strong painkillers) are often added to the local anaesthetic.
This saves the need for local anesthetics. The result is that mobility is less or not at all restricted. Thus, it is then possible for the patients to walk safely. However, all patients with PDK (epidural catheter) in place or during and after epidural anaesthesia should only stand up after consulting their doctor and/or nursing staff.
When should epidural anesthesia not be performed?
The list below lists contraindications for the use of epidural anesthesia (PDA). In individual cases, however, it is always necessary to clarify with the anesthetist to what extent there are reservations about the use of an epidural. The epidural should not be performed during epidural surgery:
- Blood coagulation disorders
- Infections/skin diseases in the area of the injection site
- Severe cardiovascular diseases
- Anemia (so-called hypovolaemia)
- Cerebral pressure elevation
Are there alternatives to epidural anesthesia?
Epidural anaesthesia is closely related to spinal anaesthesia in its performance and effect. Epidural anesthesia can be easily replaced by spinal anesthesia for all procedures below the costal arch. Spinal anesthesia is also used for pain therapy in the days after surgery. Here, however, the risk of brain water loss and infections is higher if medication is administered continuously, which is why epidural anaesthesia should be given preference. All operations that can be performed under epidural anesthesia can also be performed under general anesthesia, provided that there are no specific contraindications.
