Epidural route

Epidural analgesia is commonly used for surgery and has the following advantages:

• extended effect of drug
• intense, appropriate analgesia
• less clouding of consciousness; surgical regional anaesthesia without general anaesthesia
• can be combined with local analgesic and deep vein thrombosis prophylaxis

Disadvantages of the epidural route include:

• technical skills are required to place the line
• nurses need training in looking after the line and handle complications
• side effects are common, e.g. urinary retention
• importantly, there can be late respiratory depression and so adequate monitoring is essential during this period
• relatively expensive compared to other forms of analgesia

Common epidural analgesics include opioids such as fentanyl and local anaesthetics such as bupivacaine.

With local anaesthetics, the following complications can occur:

• hypotension
• toxicity due to inadvertent intravenous administration