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Pain treatment: epidural and spinal

During epidural and spinal pain treatment, the painkiller is administered into the subarachnoid space or the surrounding area (epidural space) by using a catheter. Your physician will use this type of pain treatment if other pain management proves ineffective or causes significant side effects.

The epidural or spinal catheter will be placed at the recovery department. We will continuously monitor your blood pressure and heartbeat. You will then receive the dose of pain treatment that best suits you. You may need to spend an average of three days at the hospital. 

Important information

Please let us know if you are taking a blood thinner. You may need to quit taking this medication several days before the procedure. Certain painkillers can affect blood coagulation. Please consult your physician about your painkillers. If you have any sensitivities to iodine, bandages, contrast agents, or anesthesia, please consult your pain specialist. X-radiation may harm an unborn child. If you are pregnant or suspect you may be, please let us know before the start of the treatment. 

More information

Catheter placement

You will be sitting upright during the placement of the catheter for epidural or spinal pain treatment. If sitting is not an option for you, you can curl up to the side with your knees pulled up during the placement. 

Anesthesia

Your anesthesiologist will disinfect your back, after which part of the skin will be covered with sterile material. A local anesthetic is administered to the area in which the catheter will be placed. 

Special technique

Your anesthesiologist will use a special technique to find the epidural or subarachnoid space for catheter placement. The needle will only enter the connective tissue between the vertebrae, never the bone or the marrow. The procedure can still cause an uncomfortable or painful tingling or “electric” sensation if the catheter comes in contact with the bone or nerves in the area. This sensation will be brief. 

Connecting the PCA pump

The catheter will then be tunneled underneath the skin towards the sides after which a PCA pump is connected to the catheter in order to administer a continuous flow of pain medication to the epidural or subarachnoid space. PCA stands for Patient Controlled Analgesia. Analgesia is another word for pain killing.

How does the PCA pump work?

Your PCA pump will be provided by your health insurance provider. The pump is small and fits into a little bag containing a drip bag and medicine case. You can keep the bag on your shoulder to bring with you, which gives you a greater range of movement. 

Pain medication dose

The pump ensures that you receive a continuous very small dose of pain medication throughout the day. You can administer an additional dose when you need it. Please press the button on the pump. Your pain specialist can determine which dose is right for you and program the pump accordingly.

Change in pain

Please contact your technical home care team if your pain levels change. They will take the necessary steps to control your pain. 

 

Side-effects

All side effects of spinal or epidural pain management are caused by the pain medication. You may experience numbness of the legs, or trouble walking, a decreased urge to urinate, itchiness, nausea, and general drowsiness. We may be able to treat these side effects by adjusting your dose. Please use a walker when receiving this type of treatment for your own safety.

Headaches and dizziness

You may experience headaches or dizziness when sitting up straight during the days after the placement of the catheter. Some spinal fluid may leak. The best treatment for these side effects is bed rest and drinking sufficient liquids.

Bleeding

In rare instances, the catheter may hit a blood vessel during placement which may cause bleeding in the epidural or subarachnoid space. This will cause weakness and sensitivity disorders in the legs.

Infection

The catheter may get infected, causing a tingling feeling at the entry, hypersensitivity, redness, or swelling surrounding the catheter, or even an abscess. You may experience a fever, pain in the lower back, weakness or sensitivity disorders in the legs, headaches, sensitivity to light or sound, and nausea. If you detect any of the aforementioned symptoms, please contact your general practitioner or pain specialist. 

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