Medical Surgical Nursing: Epidural Analgesia

Epidural analgesia is effective for managing postoperative pain because it causes a neuraxial sensory block. Furthermore, the procedure spares the motor function of the patient’s body. It only blocks his or her sensory functions. The actual blockage occurs on specific dermatomes (Apok et al., 2011). Thus, patients can ambulate effectively with minimal pain. For Mr. Johnston, this would be a recommended procedure since he underwent a left pneumonectomy. Pain in a patient who has undergone a major operation could act as a pathogen (Forero, Neira, Heikkila, & Paul, 2011). The pain induces stress in the body as well as the release of epinephrine, norepinephrine, and cortisol (Bush & Griffin-Sobel, 2003).

The release of the above chemical results in an inhibition of the proper functioning of the immune cells and hinder immunosurveillance. It can also lead to the development of residual tumor cells in the case of cancer patients. Therefore, epidural analgesia is the appropriate method of dealing with acute post-operational pain (B, M, H, S, & L, 2011). When the procedure is effective, it blocks pain-driven components of stress. The accurate inhibition of stress results in a proper function of the immune system and prevents further opportunistic infections in the body that is healing (Bush & Griffin-Sobel, 2003).

The hereditary lung complication may be difficult to prevent, but it can always be arrested in time before the lung is destroyed. On the other hand, the complication that comes as one is developing is invariably self-induced. This can be in form of poor diet, heavy smoking, lack of proper exercise, or other unhealthy practices (White, 2001). There is no universal way of relieving pain in a patient who has had a medical surgery, for distinctive patients may have distinct needs (Ruan, Tadia, Liu, Couch, & Lee, 2008).

As a nurse, therefore, it is important to ensure that each patient is given individualized attention to ensure that he or she is relieved of the pain. Mr. Keith Johnston is expected to be at his best in terms of health (especially the lungs). This is because he is not a smoker, and the complication cannot be traced in his lineage. At 27 years with regular exercise, this person was expected to be free from any lung complications. However, it may not be forgotten that when he was aged five, he was diagnosed with tonsillectomy. It is of interest to know how this complication, which would otherwise need simple procedural treatment, was handled then. In contrast, the matter at hand is that he has undergone pneumonectomy and therefore requires a pain management procedure (Zablocki, 2007).

After Pneumonectomy, a patient is always left with a lot of pain (Jackson et al, 2011). This is specifically so because an internal organ interferes with the process. To understand the pathophysiology of pain in patients, it would be appropriate to analyze the procedural steps that are taken, as well as the body’s response to the treatment being offered. According to Anderson and McFarlane (2012), the science of pain remains one of the complex biological phenomena that man is yet to discover fully.

There are still varying hypotheses put forth by various physicians who have been actively involved in the research process. However, there is an agreement that there are pain receptors in every part of the body, internally or externally (Baker, 2004). Furthermore, the pain receptors transmit pain impulses from the surface, where they are picked, and direct them to the brain.

Although some medics have hypothesized different ways through which this pain would reach the brain, all agree that it has to be transmitted to the brain for interpretation before the individual can feel it. Mr. Johnson’s lung was surgically removed since it was affected. During the process, he was given drugs to make him conscious. However, induced unconsciousness ends after some hours of operation. At this time, the pain comes raw to the patient. The nerves would pick the pain through the pain receptors and send them to the central nervous system as an impulse (Bösenberg, et al., 2005). Efforts should be made to ensure that this pain is minimized or eliminated if the patient is to be made comfortable (Vaughn, 2006).

There are various risks associated with an epidural infusion technique (Parker, et al., 2007). The patient could go into a period of severe pain when there is a dislodgment of the epidural catheter (Türe, Eti, G, Düzgün, Mutlu, & Karabağli, 2010). A standard pain scale indicates how the severity of the patient’s pain. The scale runs from zero to ten. If the displacement remains unnoticed and the infusion continues, the patient may suffer serious respiratory depression (Vallejo et al., 2007). This would happen because the absorption of the drug would not happen at an optimal rate. Some would move to the medulla (Okutomi et al., 2009).

The complication arising from the dislodgment would lead to more pain. Nevertheless, for postoperative patients, the treatment of pain has to occur as quickly and effectively as possible. Otherwise, the patient may undergo severe immune system consequences. Mr. Johnson was receiving the epidural infusion when he was resting, supine in bed. He may receive adequate measures of analgesia. However, when the patient moves, he would change his position and receive a lower concentration of analgesia. Nurses need to monitor continuously the pain score. If pain increases because of movement, then a bolus could be administered.

Local anesthetics would also be appropriate when delivered in combination. If the patient were in a sitting position, an opioid infusion would suffice to correct complications caused by transient hypotension and mild motor blocks.

Normally, the infusion solution will not show hypotension, if it only contains opiate-like morphine. The patient may suffer other side effects like nausea urinary retention and pruritis. In the case of pruritis, the patient will require an aggressive regime of antihistamines. Analgesia is one of the most effective ways of managing pain. Carrel (2011) claims this has been a popular way of eliminating pain.

Analgesia has been in use for several years and medics are still working on the discovery of more sophisticated drugs, which can be used as painkillers. Some of the most commonly used drugs include Fentanyl, Hydromorphone, and Clonidine (Shipton, 2011). These painkillers are beneficial because they are easy to administer. As Cichoki (2009) observes, a patient can take a painkiller without the help of the nurse. They are also comparatively cheap. Some have strong effects hence they would cure the pain at a relatively faster rate.


Anderson, E., & McFarlane, J. (2012). Community as partner: Theory & practice in nursing. Philadelphia: Lippincott Williams Wilkins.

Apok, V., Gurusinghe, N. T., Mitchell, J. D., & Emsley, H. C. (2011). Dermatomes and dogma. Practical Neurology, 11(2), 100-105.

B, B., M, D., H, K., S, J. T., & L, N. (2011). Mechanosensitivity before and after hysterectomy: a prospective study on the prediction of acute and chronic postoperative pain. British Journal Of Anaesthesia, 107(6), 940-947.

Baker, G., & Norton, P. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. CMAJ, 170(11), 34-41.

Baysinger, C. L., Pope, J. E., Lockhart, E. M., & Mercaldo, N. D. (2011). The management of accidental dural puncture and postdural puncture headache: a North American survey. Journal Of Clinical Anesthesia, 23(5), 349-360.

Bird, A., & Wallis, M. (2002). Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion. Journal of Advanced Nursing, 40(5), 522-531.

Bösenberg, A. T., Thomas, J., Cronje, L., Lopez, T., Crean, P. M., Gustafsson, U., et al. (2005). Pharmacokinetics and efficacy of ropivacaine for continuous epidural infusion in neonates and infants. Pediatric Anesthesia, 15(9), 739-749.

Burch, M…, McAllister, R. K., & Meyer, T. A. (2011). Treatment of local-anesthetic toxicity with lipid emulsion therapy. American Journal of Health-System Pharmacy, 68(2), 125-129.

Bush, N. J., & Griffin-Sobel, J. P. (2003). Acute postoperative pain management and malfunctioning epidural catheter. Clinical challenges, 30(2), 217-218.

Carrel, D. (2011). My dream to trample AIDS: What everyone at any age should know about HIV/AIDS. Indianapolis: Dog Ear Publishers.

Cichoki, M. (2009). Living with HIV: A Patient’s Guide. New York: McFarland.

Darvish, B., Gupta, A., Alahuhta, S., Dahl, V., Helbo-Hansen, S., Thorsteinsson, A., et al. (2011). Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey. Acta Anaesthesiologica Scandinavica, 55(1), 46-53.

Forero, M., Neira, V. M., Heikkila, A. J., & Paul, J. E. (2011). Continuous lumbar transversus abdominis plane block may spread to supraumbilical dermatomes. Canadian Journal Of Anaesthesia, 58(10), 948-951.

Jackson, S.-R., Williams, G. N., Lee, J., Baer, J. F., Warburton, D., & Driscoll, B. (2011). A Modified Technique for Partial Pneumonectomy in the Mouse. Journal of Investigative Surgery, 24(2), 81-86.

Kim, M., & Yoon, H. (2011). Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial. International Journal Of Nursing Studies, 48(11), 1315-1322.

Lim, Y., Chakravarty, S., Ocampo, C. E., & Sia, A. T. (2010). Comparison of automated intermittent low volume bolus with continuous infusion for labour epidural analgesia. Anaesthesia & Intensive Care, 38(5), 894-899.

Meyers, S. (2004). Balanced scorecards help the board make the patient safety their no. 1 priority. Trustee, 2(4), 1-4.

Mulcahey, M. J., Gaughan, J., & Betz, R. R. (2009). Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with complete spinal cord injury. Spinal Cord, 47(1), 56-61.

Murdoch, J. (2005). Ensuring prompt diagnosis and treatment of epidural abscess. Nursing Times, 101(20), 36.

N, S. E., & T, K. A. (2010). The extent of temperature sense and pain appreciation recovery in the dermatomes of cauda equine roots after lumbar intervertebral dischernia elimination. Fiziologiia Cheloveka, 36(3), 95-101.

Okutomi, T., Saito, M., Mochizuki, J., & Kuczkowsk, i. K. (2009). Combined spinal-epidural analgesia for labor pain: Best timing of epidural infusion following spinal dose. Archives Of Gynecology And Obstetrics, 279(3), 329-334.

Parker, R. K., Connelly, N. R., Lucas, T., Serban, S., Pristas, R., Berman, E., et al. (2007). Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects. Journal of Anesthesia, 21(2), 142-147.

Ruan, X., Tadia, R., Liu, H., Couch, J. P., & Lee, J. K. (2008). Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature. Journal Of Opioid Management, 4(4), 255-259.

Shipton, E. A. (2011). The transition from acute to chronic post surgical pain. Anaesthesia And Intensive Care, 39(5), 824-836.

Tixier, S., Bonnin, M., Bolandard, F., Vernis, L., Lavergne, B., E, B. J., et al. (2010). Continous patient-controlled epidural infusion of levobupicacaine plus sufentanil in labouring primiparous women: effects of concentration. Anaesthesia, 65, 673-680.

Türe, H., Eti, Z., G, F. Y., Düzgün, O., Mutlu, Z., & Karabağli, P. (2010). Histopathological effects on epidural tissue of bolus or continuous infusions through an epidural catheter in ewes. Anaesthesia, 65(5), 473-477.

Vallejo, M. C., Ramesh, V., Phelps, A. L., & Sah, N. (2007). Epidural labor analgesia: continuous infusion versus patient-controlled epidural analgesia with background infusion versus without a background infusion. The Journal of Pain, 8(12), 970-975.

Varela, H., & Burns, S. M. (2010). Use of lipid emulsions for treatment of local anesthetic toxicity: A case report. AANA Journal, 78(5), 359-364.

Vaughn, T. (2006). Engagement of Leadership in Quality Improvement Initiatives: Executive quality improvement survey results. Journal of Patient Safety, 2(2), 4-16.

White, L. (2001). Effective governance through complexity thinking and managment science. System Research and Behavioral Science, 18(1), 23-44.

Zablocki, E. (2007). IHI calls on boards to lead on quality and safety: An interview with Jim Conway. Great Boards, 7(2), 1-3.

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