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Discussion

Epidural/spinal question

Hi,

I'm a new grad and a new OR nurse. I'm confused about something.

Why would they give an epidural or spinal on top of a general anasthetic. Won't the general do the job by relaxing the mucles? Why the need to numb the person even more. Or is this stricly for post op pain control witha pca. I had a patient with a right hemicolectomy and they did an epidural and general and I dont understand why.

Also, I'm not sure if I understand the part of body that will be affected after either an epidural or spinal. i know with epidural you go into the epidural space and you can keep toping up the local and with spinal it's a one time shot of the local. They both are inserted around the lumbar region. So then will they both have the same effect on the person, as in numbing them from waist down? And the only difference is that with epidural you can keep adding and with spinal you cant? Or will they affect different parts of the body. Like, would you ever use either or for thoracic surgery or is that too high of a block.

If someone could clarify, that'd be great. I'm sort of confused here.....

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  • Admin

A PCA is different than the epidural- PCA is a narcotic that goes through the IV. An epidural is typically used with an infusion pump and works directly on the spinal cord, without the typical systemic effects of narcotics. Most patients get better pain control without the drowsiness, constipation and other narcotic side effects. We use mostly bupivicaine for ours.

Anesthetics can be given a variety of ways. By doing an epidural or spinal as well as a general, the anesthetist doesn't have to give as much medication for pain control during the case, and the patient will also have better pain control afterwards. The small dose given in the epidural or spinal does a lot more than much larger doses of narcotics given through the IV.

But pain control is only one aspect of the anesthetic. And so the patient gets a general because the purpose of the epidural/spinal is not to provide complete anesthesia, just to complement it.

For an abdominal or chest case, it's usually a thoracic epidural/spinal, which numbs the mid-section rather than the lower half of the body.

Hope that helps in your understanding!

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