Epidural and PCA at same time?...

adidas99 · Sep 19, 2005

We have new Doc on our surgical floor using both an Epidural (Fentanyl) and a PCA (MS) to manage post-op pain. Makes us floor nurses a little nervous...just wondering if there is other Doc's out there doing this? BTW..we have not noticed any better pain control just more sedate pt's.

Anesthsia ok'd this?

Larry77, RN · Sep 19, 2005

Anesthesiologist is the "new doc"...I wonder how the ortho docs feel about this...I'm sure they are discussing it. I will continue to watch my pt's who are on both very closely...I always have VS checked more frequently than ordered and am very careful with any PRN's I administer.

lady_jezebel · Sep 19, 2005

It's OK in our hospital as long as a narcotic is used in only one of them. For our ortho/surgical pts with both, there is usually bupivicaine (or some other numbing drug) on continuous infusion from the epidural pump, while the PCA pump delivers morphine or dilaudid as a continuous infusion and/or demand dose only.

meownsmile, BSN, RN · Sep 20, 2005

Wow,, 24 hours of epidural for a total knee? Some of our arthroplasties come back with a PCA, but others arrive with IV prn. Our orthos dont use epidurals post op except for maybe an occasional block given right before they leave the PACU. They do just fine and are usually up that night of surgery in the chair for half an hour or so. By day 2 post op they are usually taking po pain meds and are off all IV fluids.

DutchgirlRN, ASN, RN · Sep 20, 2005

I only see epidurals used for pain control with major abdominal surgeries such as a whipple procedure or colon resection. I have never heard of using a PCA at the same time. Occasionally an epidural patient will require a breakthrough pain med. Never a PCA. That would make me nervous. I hope you're keeping Narcan taped by the bedside ! YIKES !

P.S. Never give Nubain for itching to an epidural patient. It works like Narcan. All the anesthesioligists order it, we never give it. I've made that mistake once and oh it was not a good thing. It took me at least an hour to get the pain under control again and I felt so so bad. I've heard 5mg Nubain doesn't reverse the epidural but I'm not taking any chances, I'm not ever giving it again.

adidas99 · Sep 20, 2005

Bupivicaine is what we use in our epidural pumps as well.