[Nellie Nurse]

I work in a Ortho/Neuro unit with many ortho surgeries. The patients are given a choice preop of epidural vs. PCA for pain management postop. I can't stand the epidurals. I don't think that they have as good pain control as the PCAs, I find that I have to give the patients two to three different meds plus a epidural bolus and rate increase to achieve pain control for these patients. Many times the people with PCAs don't need any additional pain med to help with pain control.

What is your experience. Do you have any advice that would help me better manage the pain for the patients who have chosen the epidural route?

[sharann]

Nellie, they should get BOTH. Yes, both. Let me explain. They should get an Epidural pre-op which should be bolused prior to waking the patient from general(anesthesia does this of course). Then, in the PACU start the PCA. The patients do fantastic at our hospital but there needs to be a consistency to using this method. Most people who elect to forego the epidural wake up screaming bloody murder and are some of the most difficult to control post-op pain in. We start the PCA's in our PACU, but some may elect to wait until patients get to the ortho floor. I don't believe that waiting is in the patients best interest since the patient may be in pain unecessarily.

[sharann]

I'm sorry, I just realized that Nellie may have been talking about a continuous epidural infusion vs a PCA. In that case my experience is that patients do far better with the pre-op epidural injection(single shot) then the PCA immediately postop. I think the continuous epidural has many more issues an problems to contend with and are riskier. Of course, if the patient is a special case(highly drug addicted or have had bilateral knee surgery) then and epidural certainly is fine.

[ahmad]

hi maybe am late to reply but am new here, according to my experience their is no analgesia can make pain free alone, as you know their is different types of pain(viscral,neuropathic,somatic like bone pain,etc) so the combination of drugs is the effective its called balance analgesia. epidural analgesia will depend on many things the opioid type(hydrophilic vs lipophilic
and on the operation site and on the type of pain. in case of Ortho operation the epidural will be effective as it block sensations and will be effictive also for phantomp pain but the bone pain will strongly relived by NSAIDs not epidural, so my experience and the articles taught me to treat pain depending on my assessment of pain types .