Key Points

Injections of narcotics

Constant rate infusions of narcotics

Epidurals Incisional catheters

Oral meds – narcotics, nonsteroidals

Nursing care

Pain perception

Epidural Analgesia

• Epidural analgesia is very useful to control pain during and after surgery of the hindlimbs, tail, perineum, anus, and rectum. The analgesic effect of an epidural injection typically lasts for 12 to 24 hours.
• This is an example of an epidural injection of local anesthetic and morphine to control pain prior to an orthopedic surgery
• A patch of hair is shaved over the back above the base of the tail and the skin is cleansed with an antiseptic to prevent infection.
• A needle is inserted into the lower spine (lumbosacral junction). A drop of fluid is placed in the hub of the needle; if the fluid drop is sucked into the spine the anesthetist knows for sure that the needle is in the correct position.
• A syringe containing a narcotic and long-acting local anesthetic is injected.
• Side effects of epidural analgesia includes weakness of the hindlimbs, urinary retention/urinary leakage and delayed hair regrowth over the site of the epidural injection. These side effects are transient and resolve within 24 to 36 hours after the injection has been given.

Epidural Catheter Placement

• A patch of hair is clipped off the region of the lumbosacral junction and the skin is prepared asectically
• A fenestrated drape is placed over the patient
• A small stab incision is made with a number 11 scapel blade in the region of the lumbosacral junction
• A Touhey needle is directed into the epidural space
• The stylet of the needle is removed and the hub is filled with Lactated Ringer’s solution. Note that the fluid is drawn down the needle into the epidural space.
• An epidural catheter is placed down the needle into the spinal canal
• The needle is removed, a filter is placed on the catheter and an injection port is placedd on the filter.
• The drape is then removed and the skin is sprayed with an adhesive
• A sticky plastic drape (Ioban) is placed over the catheter to secure it in place.
• Preservative free morphine is injected into the catheter. Prior to each injection we recommend cleansing the port with an antiseptic (chlorhexidine solution).