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PatientControlledEpiduralAnalgesia(PCEA)4 Ed,4/11 th

Epiduralanalgesiawithlocalanesthetics,opioids,oralphaagonistsalone,orincombination,canprovide
superiorregionalanalgesiaoverconventionalsystemicroutes(IVorPO)withminimalsystemicside
effects(nausea,sedation,constipation).Drugsadministeredepidurallyaredistributedbythreemain
pathways,including:
1) diffusionthroughtheduraintotheCSF,thentothespinalcordornerveroots;
2) vascularuptakebythevesselsintheepiduralspaceintosystemiccirculation;and
3) uptakebythefatintheepiduralspace;creatingadrugdepotfromwhichthedrugcaneventually
entertheCSForthesystemiccirculation

Epiduralanalgesiacanbeadministeredinseveralways:byintermittentboluses(byaclinicianorby
patientcontrolledepiduralanalgesia(PCEA)usinganappropriatepump),continuousinfusion,ora
combinationthereof.PCEAisoftenusedtosupplementabasalratetoallowapatienttomanage
incidentpainrelatedtopostoperativerecoveryactivitiesandhelpsmeetindividualanalgesic
requirements.LikeIVPCA,PCEAcanprovidemoretimelypainrelief,morecontrolforthepatient,and
convenienceforboththepatientandnursetoreducethetimerequiredtoobtainandadminister
requiredsupplementalboluses.Iflocalanestheticisused,thelockoutintervalshouldbeatleast15
minutestoallowforpeakeffectofthesupplementallocalanestheticdose.

MonitoringIncontrasttodrugsadministeredsystemically,drugsadministeredintheepiduralspaceare
extremelypotentbecausethedrugisbeingdeliveredclosetothesiteofaction(opioidandalpha
agonistreceptorsinthedorsalhorn;localanestheticblockadeofnerveroots),therefore,frequentand
ongoingassessmentofpainrelief,sideeffects,andsignsorsymptomsoftechnicalcomplications
(catheterdislodgement,epiduralhematomaorabscess,pumpmalfunction,etc.)arenecessary.

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PainFastFact:PatientControlledEpiduralAnalgesia(PCEA)continued

FollowtheEpiduralandIntrathecal(Neuraxial)Analgesiapolicy
forassessmentanddocumentationrequirements

Everyhourforthefirst24hours,thenevery4hours,assessanddocumentthefollowing:
Respiratoryrateandsedationlevel,preferablybythesamenurseduringeachshift
Every4hourswhiletheepiduralisinplace
Patientspainratingusingpatientspecificpainscale(e.g.010),bothatrestandwithactivity
Sideeffectssuchaspruritus,nausea,urinaryretention,orthostatichypotension,motorblock
Every8hourswhiletheepiduralisinplace
Catheterinsertionsiteforsignsofinfectionorepiduralabscess,e.g.,backpain,tenderness,
erythema,swelling,drainage,fever,malaise,neckstiffness,ormotorblock
Anychangesinsensory/motorfunctionthatmayindicateanepiduralhematomaincluding
unexplainedbackpain,legpain,bowelorbladderdysfunction,motorblock

SelectedReferences:
MannCetal.Postoperativepatientcontrolledanalgesiaintheelderly:risksandbenefitsofepiduralversus
intravenousadministration.Drugs&Aging2003;20(5):33745.
AntokEetal.Patientcontrolledepiduralanalgesiaversuscontinuousepiduralinfusionwithropivacainefor
postoperativeanalgesiainchildren.Anesthesia&Analgesia2003;97(6):160811.
PaseroC,EskterowiczN,PrimeauM,Cowleyc.Registerednursemanagementandmonitoringofanalgesiaby
cathetertechniques:positionstatement.PainMgmtNurs2007;8(2):4854.

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UniversityofWisconsinHospital&Clinics,Madison,WI
Internet:Visitwww.uwhealth.org/pain
Intranet:MoreFastFactsinUConnectunderClinicalGuidelines/PainManagementResources