EPIDURAL ANALGESIA 
What is an Epidural?
Through this catheter you will receive pain medicine, either by injection or via a machine especially programmed to meet you’re an epidural refers to a technique in which an Anesthesiologist passes a soft plastic tube into the epidural space needs safely.
What Types of Patients Receive Epidurals?
Several examples include patients for total hip or knee surgery, thoractomy, abdominal surgery, various gynecological and urologic procedures as well as cesarean sections. In addition, certain non-surgical patients may be eligible such as those with pancreatitis or colic from kidney stones.
How Can I decide an Epidural is Right for Me?
Discuss this with your doctor in surgery clinic or your doctor in hospital.
When Would I Get My Epidural Catheter?
It would be inserted at the beginning of your procedure in the operating room or in recovery room in the operating suite.
Does This Mean I Have to Be Awake during My surgery?
Some patients elect to have a general anesthetic, but sometimes you can have an epidural with sedation so you are you are comfortable and sedated. Towards the end of your procedure, the epidural will be injected with pain medicine so you will be comfortable when you wake up.
If I Have Had Back Surgery in The Past, Can I Still Have an Epidural?
An Anesthesiologist individually assesses each patient and this will be discussed with you after a thorough examination.
Does This Mean I Will Be Numb And Not Able To Move My Legs?
No. We aim to have you comfortable without being numb so you can move your legs. Some times your legs may feel numb, heavy and tingling. This is not unusual. If any of these occur a member from the Pain Team will change the epidural pump setting or may change the medication.
What Are Some of The Side Effects With This Technique?
Generally speaking this procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications i.e. itching, nausea, vomiting, sedation and urinary retention are the most common side effects. Other risks involve spinal puncture with headaches, infection and bleeding inside the epidural pump setting. At this time, a urinary catheter maybe inserted temporarily.
How Long Do These Catheters Stay in Place?
The Epidural Catheter remains in place for as you need pain relief. The catheter must also remain in its correct position, or it will be removed. The period of placement may vary from two days, or up to a maximum of two weeks. During the time the epidural catheter is in place, the pain team will visit you everyday to make sure you are comfortable and check your epidural catheter position.
PATIENT CONTROL ANALGESIA
What is Patient Control Analgesia?
PCA stands for patient controlled analgesia. Analgesia simply means relief of pain. With patient controlled analgesia, patients are able to give themselves their own dose of pain-reliving medication, after your operation or injury. You will decide when you need pain medicine and by pushing the button, you will receive a dose of pain medication to cease your pain.
How Dose the PCA Work?
The PCA system consists of two parts: a computerized infusion pump, which is kept next to the bed, and a control button at the end of a cable, which you keep at your side. The physician will prescribe the amount of pain medicine and the maximum safe doses that is tailored to meet your needs best. This information will be programmed into your PCA machine. To receive a dose of medication, all you need to do is press the control button and the medication will be delivered through the canula into your bloodstream. Because the medicine goes into your bloodstream, you have to wait usually 5-6 minutes after you received the dose for it to start to work. The effect of the medication will be felt within 5-10 minutes. It is common to have to press the button several times each hour to keep the pain under control. If you are still in pain, you can push the button again, but remember you can only receive the medication after a certain time that is programmed. This is a safety measure to prevent overdose of medication. Your machine has several safety features and an alarm system. The total amount you can give yourself, within each hour is within safe limitations.
When Should I Push the Button?
When you feel initial discomfort or pain, push the button to give your self pain medicine. Prior to mobilization or starting your activities that cause discomfort such as turning, walking, deep breathing or coughing. You may give a dose of pain medication to help minimize the pain. Give yourself enough medication to be comfortable. Do not wait until the pain is severe before pushing the button. It is common to have to press the button several times each hour to keep the pain under control.
Can I Give Myself Too Much Medicine?
No. The PCA machine is programmed to give you an exact amount of medicine with a minimum safe time between doses. You will quickly learn how often you need to push the PCA button to control the pain and remain alert. No person, other than you, should press the button.
Is there any Side Effect I should look for?
People respond differently to medicine. Sometimes, pain medicine can cause itching, nausea, itching anxiety, difficulty in focusing your eyes and emptying your bladder. You may at times also feel sleepy. If you notice any of these mentioned, notify your nurse immediately. If you have had a problem with pain medication in the past, please discuss this with your health care provider.
Can I Get Addicted?
No. Research has shown that addition in hospitalized patient is not a problem. Patients who use PCA machines have their pain management requirements met far better than those patients receiving intermittent analgesia from the nurse.
Who Looks after My PCA?
The nurse taking care of you will check with you to make certain you are comfortable, and that you are using the pump correctly everyday. A member of the Acute Pain Service will visit you and assess your pain medicine requirements and tailor the medicine to your needs. They are available to answer any of your questions. Please tell your doctors and nurses if you are unable to control your pain, the amount of the medication you receive may need adjustment to help you be more comfortable. It is important to tell your nurses and doctors how your pain medicine is working so; they can change the dose, its timing or medication if your pain is not controlled. The PCA will be discontinued when your doctor and nurse feel you are ready to take pills that can relieve.
What Else should I Know about My PCA?
Only you should push the button because you know when you are in pain. A visitor or family member should not push it for you. If you have any further questions about your PCA, please ask your doctor or nurse and they will be happy to help.