From the Guidelines
Peridural analgesia, also known as epidural analgesia, is a highly effective pain management technique that involves delivering medication directly into the epidural space of the spine to block pain signals, and is recommended for use in major surgeries, including open rectal surgery, for 48-72 hours, as it provides superior pain relief compared to systemic opioids 1.
Key Points
- The epidural space is located just outside the dura mater, which is the protective membrane surrounding the spinal cord.
- Medications typically administered include local anesthetics like bupivacaine, ropivacaine, or lidocaine, often combined with opioids such as fentanyl or sufentanil.
- The medication is delivered through a thin catheter inserted by an anesthesiologist using a needle between the vertebrae, allowing for continuous administration over hours or days.
- The procedure provides effective pain relief while allowing patients to remain conscious and, in many cases, mobile.
- Side effects may include hypotension, urinary retention, itching, and rarely, headaches or infection.
Benefits and Recommendations
- Epidural analgesia is recommended for open rectal surgery for 48-72 hours, as it provides superior pain relief compared to systemic opioids 1.
- For laparoscopic approaches, epidural or intravenous lidocaine, in the context of an enhanced recovery after surgery (ERAS) program, provides adequate pain relief and no difference in the duration of hospital stay or return of bowel function 1.
- Multimodal analgesia with paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) has been shown to spare opioid use and side effects by 30% 1.
- Cyclo-oxygenase (Cox)-2 inhibitors can be used safely in conjunction with epidural anesthesia, but recent studies have highlighted a possible association between ibuprofen, diclofenac, and celecoxib and a higher incidence of anastomotic dehiscence 1.
From the FDA Drug Label
During epidural administration of bupivacaine hydrochloride, 0.5% and 0. 75% solutions should be administered in incremental doses of 3 mL to 5 mL with sufficient time between doses to detect toxic manifestations of unintentional intravascular or intrathecal injection. Peridural analgesia, also known as epidural anesthesia, is a type of regional anesthesia that involves injecting a local anesthetic, such as bupivacaine, into the epidural space surrounding the spinal cord to block pain signals.
- The goal of peridural analgesia is to provide pain relief without causing significant motor blockade or respiratory depression.
- It is commonly used for surgical procedures, such as childbirth, abdominal surgery, and orthopedic surgery. 2
From the Research
Definition of Peridural Analgesia
Peridural analgesia, also known as epidural analgesia, is a method of pain relief that involves the injection of anesthetic or analgesic medications into the epidural space surrounding the spinal cord. This technique is commonly used to manage postoperative pain, labor pain, and chronic pain.
Types of Peridural Analgesia
- Patient-controlled epidural analgesia (PCEA): This involves the use of a patient-controlled device to administer a continuous infusion of anesthetic or analgesic medications into the epidural space, as seen in the study by 3.
- Continuous epidural infusion: This involves the continuous infusion of anesthetic or analgesic medications into the epidural space, as seen in the studies by 4, 5, and 6.
- Bolus administration: This involves the intermittent injection of anesthetic or analgesic medications into the epidural space, as seen in the study by 7.
Medications Used in Peridural Analgesia
- Bupivacaine: A local anesthetic commonly used in epidural analgesia, as seen in the studies by 3, 4, 5, and 6.
- Fentanyl: An opioid analgesic commonly used in combination with bupivacaine in epidural analgesia, as seen in the studies by 3, 4, and 5.
- Morphine: An opioid analgesic that can be used in epidural analgesia, as seen in the study by 7.