Epidural analgesia technique

Introduction

• The epidural analgesic technique offers improved efficacy and greater duration compared to systemic analgesic techniques.

Uses

• For analgesia of the abdomen, perineum, pelvis and pelvic limbs.
• Can be used to supplement general anesthesia in hind limb orthopedic procedures.
• Can be used with mild to moderate sedation for Cesarean section. .

Advantages

• High quality analgesia.
• Long duration (up to 24 hours).
• Minimal side effects.

Disadvantages

• Skill required to perform the technique.

Preparation

• 5 minutes.

Requirements

Materials required

Minimum consumables

• Spinal needles.
• Syringes.
• Local anesthetic .
  This will cause complete anesthesia and loss of motor control.
• Morphine .
  This will provide excellent analgesia but no loss of motor control. Opioids alone are not sufficient for surgery in a conscious dog.
• Sterile isotonic saline solution.
• Sterile gloves.

Ideal consumables

• Preservative-free solutions of local anesthetic and morphine.
• Glass syringe.
  A glass syringe is ideal for determining loss of resistance during epidural injection.
  

Sequelae

Complications

• If blood is observed in the spinal needle at any time, the needle should be removed and the procedure re-started.
• Hair re-growth over the lumbosacral space is typically slow and may re-grow white in dark-haired animals.
• Infections are rare when aseptic technique is performed.

Reasons for treatment failure

• Failure to provide adequate analgesia even when all indications that the injection was good will occasionally occur, possibly reflecting the individual's high analgesic requirement for that particular surgery.
  

Sources

Publications

• Recent references from PubMed.
• Troncy E, Junot S, Keroack S et al(2002) Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997-1999). JAVMA 221 , 666-672 PubMed.
• Jones R S (2001) Epidural analgesia in the dog and cat. Vet J 161 (2), 123-131 (Review)PubMed.
• Hendrix P K, Raffe M R, Robinson E P, Felice L J & Randall D A (1996) Epidural administration of bupivacaine, morphine or their combination for postoperative analgesia in dogs. JAVMA 209, 598-607PubMed.