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Epidural Analgesia Flowchart

Epidural
Decision
Making

Stable patient.*
Morphine 1 0.1 mg/kg + Surgery is
Lidocaine 2 3 mg/kg Y Caesarea Y abdominal
n or below and
to a total volume 4 of 6 mls significant.
section?
or 0.3 mls/kg whichever is less. hemorrhage
is not expected.

Morphine 1 0.1 mg /kg +

Bupivicaine 3 1 mg/kg Y Abdominal
to a volume 4 of 0.3 mls/kg procedure?
or 9 mls whichever is less. N

N Morphine 1 0.1 mg/kg

Morphine 1 0.1 mg/kg +
Bupivicaine 3 1mg/kg
to a volume 4 of 0.2 mls/kg
or 6 mls which ever is less.
to a volume 4 of 0.3 mls/kg
maximum 9 mls
(omit local anesthetic)
Hind limb
Y or
pelvic procedure?

* Normal vital signs, circulating blood volume

with hematocrit above 30%.
1 Morphine preservative free single dose vial
2 Lidocaine 2% single dose vial no epinephrine
3 Bupivicaine 0.5% single dose vial no
epinephrine
4 normal saline single dose vial
For dose calculations see pages 6-32 to 6-40

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Pain Control 6-1
Veterinary Anesthesia Update www.nancybrockvetservices.com

Epidural Morphine Analgesia

Indications:
Intra and post-operative analgesia for pelvic, hind limb, abdominal, thoracic and forelimb
surgery
Benefits:
Reduces necessary dose of inhalant anesthetic
Helps maintain a steady plane of anesthesia
Provides post-operative analgesia lasting up to 24 hours without the CNS depression
Provides post-operative analgesia without ataxia or motor weakness
Disadvantages:
Insufficient for surgical analgesia in conscious patients
Supplemental systemic post-operative analgesia may be necessary
Slow onset of action (30 to 60 minutes) therefore best administered immediately after
anesthetic induction
When administered post-surgically, analgesia is less effective NOTE
Possible delayed CNS depression and respiratory depression 12 to18 hours post
epidural (rare)
Urinary retention in the first 24 hours post-epidural injection (rare)
Contraindications:
Coagulopathy
Sepsis
Hind limb neurological impairment
Lumbo-sacral instability or arthritic changes
Dose:
0.1 mg/kg in 0.3 cc volume
Preservative free, sterile, single use vials
Maximum volume 6 mls for Caesarian section otherwise 9 mls

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Pain Control 6-2
www.nancybrockvetservices.com Veterinary Anesthesia Update

CALCULATING EPIDURAL DRUG DOSES-

Morphine
In Canada use morphine 10-mg/cc single use ampoule with or without
preservative:
Body weight (kg) X 0.1 mg/kg = ______ cc morphine (A)
10 mg/ml (Canada)
Total drug volume = _______ cc (A)

In USA use single use ampoule of preservative free morphine 1 mg/ml:

Body weight (kg) X 0.1 mg/kg = ______ cc morphine (A)
1 mg/ml (USA)
Total drug volume = _______ cc (A)
If epidural block is intended for pelvic or hind leg surgery, do the following calculations
to adjust total epidural volume:
Body weight (kg) X 0.2 cc/kg = Total epidural volume = ______ cc's (C)
(C) Minus (A) = ccs of sterile saline to be added = ______cc's (D)
D + A should equal C
If epidural block is intended for laparotomy, chest or forelimb surgery, adjust total
epidural volume:
Body weight (kg) X 0.3 cc/kg = Total epidural volume = ______ cc (C)
(C) Minus (A) = ccs of sterile saline to be added = ______cc (D)
D + A should equal C
Do not exceed 6 ccs total volume for Caesarian section otherwise do not exceed 9 ccs total
volume.

(Laminate and re-use this worksheet)

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Pain Control 6-3