Management of Epidural Analgesia

Nurses General Nursing

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I know that epidural analgesia targets nerve bundles of the lower extremities...

So my question is, how do I know if a patient's c/o leg numbness is just a sensory/motor block to which the analgesia needs to be titrated OR if this is actually an indication of epidural hematoma? Do I notify the physician either way? (When assessing the epidural site, can you actually SEE the hematoma?)

Any feedback would be appreciated.

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Anyone?

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Is it actually an epidural or a peripheral block like a femoral nerve block or lumbar plexus?

If it is truly an epidural with one side noticeably more affected, I would definitely notify the MD or CRNA. If nothing else, at least s/he would be aware.

I did see a hematoma around a insertion site--just looked like a ugly, oozing bruise. I "bothered" the CRNA enough, he came and looked at it, it was pulled. The hematoma was still funky looking on discharge a few days later.

Hope this helps some.

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Specializes in pediatrics, palliative, pain management.

No you can't see an epidural hematoma at the insertion site. An epidural hematoma is not just a hematoma at the insertion site (i.e. a hematoma just under the skin). The hematoma occurs in the epidural site and can push into the spinal space causing pressure onto the spinal cord. An epidural hematoma is an emergency situation that requires an MRI to diagnose and surgery to treat. If an epidural hematoma is not acted upon it can result in permanent paralysis! There should be guidelines and education material available at your hospital that help guide you -- ask! If you are responsible for providing care for a patient with an epidural and are not sure about this that is really something you must act on -- talk to your educator/ charge nurse etc.

The UK did a major review in 2010 about epidural complications including epidural hematomas. They consider all motor blocks to require action -- basically we should not expect a motor block (with a move towards thoracic epidurals anyways) and the only way to rule out a hematoma is to reduce the infusion rate and ensure the motor block resolves. Here is link to their full document and appendicies that address how to deal with a motor block 3rd National Audit Project (NAP3) | The Royal College of Anaesthetists

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