epidural vs. spinal nursing care in PACU

brownbook · Aug 18, 2010

Sorry I don't know. I couldn't find much difference in my quick Internet search. We stopped using spinals at our clinic so I'm out of "practice" with either one.

I am however an expert at thinking my questions are STUPID. Don't be like me!!! Ask the anesthesiologists, I know I feel DUMB when I ask a question about something I have been taking care of for years, but just ask. Doctors like plain simple direct questions, many doctors like to teach.

"Can you please tell me the difference between spinal and epidural and do I need to look for different side effects?" Try to ask when they aren't too busy.

allnurses Guide · Aug 19, 2010

There really isn't much of a difference that you will notice if they have both been only used for surgery, and actually both are classified as neuraxial anesthesia. What I tell my patients is that an epidural goes into the epidural space and has to soak through a membrane (the dura) to take effect so it takes about 20 minutes for the medicine to take full effect, but epidurals are usually done with a catheter similar to an IV catheter tubing that allows them to be titrated to effect. With spinals the medicine goes directly into the CSF and takes effect almost immediately, but cannot be titrated to effect. Spinals are usually a one shot deal.

The importance in PACU is to make sure the level is receding back to normal or with an epidural that is still infusing that a proper level is being maintained. You never want to have a level higher than T-4 (higher than that can cause the cardiac accelerator fibers to be effected and the patient can become severely bradycardiac or asystolic), and you should never have a level that isn't relatively stable or not receding. A level that is increasing without being bolused or having the rate increased if the epidural is on a pump can indicate an emergency from an epidural hematoma pressing on the spinal cord.

Hope that helps.