Page 51 - Urological Health

Epidural analgesia

This is similar to a spinal anesthetic but with certain technical differences. The local anesthetic drug
is injected slightly less deeply than for a spinal anesthetic such that the spinal fluid compartment is
not entered. Usually a very thin plastic tube is inserted into this space and can be left in place for
several days. This can have local anesthetic and other painkillers slowly and continuously dripped
down it and can be used to relieve the pain of major surgery. Epidurals are usually placed before you
are given a general anesthetic and then used for pain relief after the surgery.

Table 1. Advantages and disadvantages of spinal anesthesia

Advantages
From the patient’s view:
• Reduces nausea and vomiting after surgery
• Patients can eat and drink sooner (depending on type of surgery)
• Residual postoperative analgesia - often for many hours
• Faster initial wakeup and recovery

From the anesthesiologist’s view:
• Decreased blood loss for certain major surgeries
• Decreased rate of leg blood clots after certain major surgeries
• Allows verbal communication with patient
• No atmospheric pollution with anesthetic gases
• Less expensive
• Avoids risk of very rare complications of general anesthesia
• May be better for patients with lung diseases

Disadvantages
From the patient’s view:
• Patients often prefer to be asleep
• Fear of the unknown
• Anxiety about environment in the operating room (noises of instruments)
• Potential for discomfort for long cases from lying on the operating room table
• Legs may be weak or numb for several hours after the surgery
• Fear of insertion of needle into back

From the anesthesiologist’s view:
• Occasionally causes fall in blood pressure
• Difficulty passing urine occasionally in immediate postoperative period
• Occasionally difficult to perform in elderly or arthritic patients
• Rare potential for nerve damage

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