Royal Manchester Children s Hospital Epidural Infusions for Pain Relief Including Discharge Advice Children s Pain Team- Information For Parents and Carers
This leaflet aims to provide information for parents of children who may benefit from an epidural for pain relief after surgery. It explains: What an epidural infusion is. How an epidural infusion controls your child s pain. What possible side-effects your child may experience. What is an epidural infusion An epidural is a very good method of providing pain relief for your child during and after their operation. A small thin tube called an epidural catheter is placed into your child s back when they are asleep in theatre. A local anaesthetic liquid is then given through an infusion pump which will numb areas of your child s body where the operation has been carried out. The local anaesthetic infusion (epidural infusion) can provide pain relief to your child for up to four days. However the duration of the epidural time will depend on your child s age and the type of operation. Will the epidural catheter fall out? The epidural catheter is kept in place with tape and a clear dressing. Your child s nurse will check that the catheter is secure when changing your child s position, usually every 3 hours. Why should I consider an epidural infusion for my child? An epidural infusion provides very good pain relief and is less likely to cause shallow breathing, make your child sleepy or cause nausea and vomiting as some other types of pain relief. Your child should be able to turn over in bed, sit forward, cough and take deep breaths with little or no pain. 2
How will the nurses look after my child with an epidural? Before your child has their operation the anaesthetist will visit you on the ward and talk to you and your child about the epidural infusion. When the epidural infusion is in place the nurse will check your child s heart rate, blood pressure, breathing, level of pain and limb movements (your child will be asked to wriggle their fingers or toes) every hour. Your child will have a red light attached to their finger; this is connected to a machine called a saturation monitor. This machine will check your child s heart rate and oxygen levels in their blood all the time. The nurse will ask your child about their pain, they may also ask you how you think their pain is. The nurse will assess your child s pain using a pain assessment chart. You must tell the nurse if you feel that your child s pain is not controlled. If there are any problems with the epidural or if your child s pain is inadequately controlled then the nurse will contact a member of the children s pain team or an on-call anaesthetist. Are there any side effects? This scale is to help illustrate possible risks: Very common Common Uncommon Rare Very Rare 1 in 10 1 in 100 1 in 1,000 1 in 10,000 1 in 100,000 Very common and common side effects and complications (Seen in 1 in 10 to 1 in 100 children) All common side effects can happen with or without an epidural following surgery. Common side effects are usually minor and easy to treat. They include: 3
Itching. Itching may be caused if a morphine-like drug is added to the local anaesthetic in the epidural. The nurses can give your child some medicine in their drip to relieve this. Low blood pressure. This is treated by giving your child fluid through their drip. Feeling sick/vomiting. This may be a side effect usually if a morphine-like drug is added to the epidural. The nurse can give your child some anti-sickness medicine in their drip to help if this occurs. Difficulty passing urine. Usually your child will have a tube (catheter) put into their bladder whilst under anaesthetic. If not then occasionally your child may have difficulty passing urine. If this happens then a small tube may need to be put into your child s bladder to empty it. Temporary numbness and feeling of heaviness in legs /arms. Sometimes your child will experience numb and heavy feelings in their arms or legs due to the local anaesthetic in the epidural. If this happens then the epidural may be reduced. Once the epidural is stopped these feelings will wear off. Inadequate pain relief. If the local anaesthetic doesn t spread evenly or adequately enough to cover the whole surgical area or there is excessive leaking or dislodging of the epidural catheter then an alternative form of pain relief will be given. Uncommon Complications (Seen in 1 in 1,000 children) Headaches. Occasionally a severe headache can occur which is worse on sitting up or standing. This may be caused by leak of spinal fluid if the dura (a thin membrane surrounding the spinal cord) is punctured by the epidural needle. Most headaches will get better on their own. If your child s headaches persist then the puncture in the dura can be plugged by inserting a small amount of your child s blood into the epidural space. 4
Pressure sores. Following surgery your child may be less mobile than usual. The epidural may also reduce sensitivity in the legs. This can make them more vulnerable to pressure sores during the epidural infusion. To prevent this, your child will be given regular pressure relief and encouraged to move. Pressure relieving devices may also be used. Epidural catheter site infection. The insertion site in the skin can become infected, in which case the epidural will be removed and your child may need antibiotics. It is very rare for the infection to spread any further. Rare and very rare side effects and complications (Seen in 1 in 10,000 to 1 in 100,000 children) Rare side effects of an epidural include convulsions (fits), breathing difficulties, infection in the spine and temporary nerve injury. Permanent nerve damage or cardiac arrest are very rare indeed and these risks should be balanced against the effective pain relief which epidurals can provide. To put these risks into perspective, children are more likely to be fatally injured on the road than experience permanent nerve damage from an epidural. All of the above risks are approximate, assume good practice and are based on national audit results. Frequently asked questions: How can I support my child? You can help reduce your child s stress and pain level by simple methods of distraction such as play, talking or reading to them, massage, cuddles and also by encouraging them to take any prescribed pain relieving medicine. 5
What happens when my child no longer needs the epidural infusion? Your child s nurse will have discussed the removal of the epidural with a member of the pain team or an anaesthetist. When the epidural infusion is stopped it takes a few hours for the effects of the epidural infusion to wear off totally. Your child s pain will be controlled with other forms of pain relief so they should have little or no pain whilst the epidural is wearing off. How does the epidural catheter come out? The epidural catheter can be pulled out easily and it should not hurt your child, however some children find having the tape removed a little uncomfortable. What can I do if I am worried? If you have any worries or questions about your child s pain then please talk to your child s nurse. You could also ask to speak to one of the children s pain nurses or an anaesthetist. Discharge advice after the epidural Following discharge home, your child may continue to need regular pain relief. On removal of the epidural catheter, a small plaster will be placed over the epidural site. Complications following removal of an epidural are rare. To minimise any possible complication it is important to inspect the site on a daily basis. If your child has any of the following symptoms within a week of the epidural being stopped then contact us as soon as possible or take your child to A&E. Severe back pain, redness, swelling or discharge at the epidural site. Changes in feeling/strength in legs. Difficulty in passing urine. Severe headaches when sitting or standing. Fever along with any of the above. 6
Contact details Monday Friday 7.30 am 4.00 pm The Children s Pain Team 0161 701 5626 or call the hospital switch board on 0161 276 1234 and ask them to bleep 1070 or 1073. Out of these hours: contact the hospital switch board on 0161 276 1234 and ask them to bleep the on-call Paediatric Anaesthetist. Useful organisations Association of Paediatric Anaesthesia of Great Britain and Ireland Churchill House 35, Red Lion Square London, WC1R4SG Tel: 020 7092 1739 E-mail apa@rcoa.ac.uk This is a professional organisation which focuses on standards in anaesthesia and children s pain relief. References Llewellyn N, Moriarty A (2007); The National Paediatric Epidural Audit, Paediatric Anaesthesia; 17(6): 520-33 Giaufre E, Dalens B, Gombert A (1996); Epidemiology and morbidity of regional anesthesia in children: a one year prospective survey of the French-Language society of pediatric Anesthesia. Anesth Analg 83: 904-12 7
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