Epidural analgesia

Your child's surgeon or anaesthetist may suggest that your child has an epidural for control of pain after an operation. Epidurals are widely used for major operations involving the chest, stomach (abdomen) or lower limbs. An epidural will only be suggested if your surgeon and anaesthetist believe that it will provide the best pain relief and recovery for your child. There is usually less vomiting after use of an epidural and this often allows your child to start eating and drinking sooner and helps them to get better faster.

Your anaesthetist will explain in more detail the benefits and potential risks of having an epidural, as well as the alternatives to an epidural.

How does it work?

When your child is asleep (under general anesthetic) for the operation, the anaesthetist will insert an epidural tube (catheter) into the space surrounding the nerves after they have left the spinal cord (this is known as the epidural space).

The epidural catheter is a very thin plastic tube that looks like nylon fishing line. It is inserted through a special needle, which is removed once the epidural catheter is in place. The epidural catheter is then covered with tape and a plastic dressing is placed on your child's back.

The epidural catheter will stay in place after the operation and will be connected to a pump. A mixture of pain relieving medicines will then be delivered constantly through the catheter to give pain relief to your child.

This pain relieving mixture will contain a local anaesthetic which numbs the nerves and other pain relieving (analgesic) drugs.

Is it safe to have an epidural?

Epidurals are effective and safe for children of all ages. Safety is maximised by having skilled staff caring for your child's epidural, checking doses and equipment, and carefully checking your child's pain level and progress. This will include checking your child's breathing, heart rate, blood pressure and movement.

Like most medical procedures, epidurals carry some risk. Your anaesthetist or surgeon is the best person to help weigh up the benefits and risks for your child.

The most serious risks include a severe reaction to the drugs used, or harm to the nerves in the spinal cord; however this is extremely rare.

Less serious problems such as headache, itchy skin, vomiting or infection are also uncommon.

An epidural may lower your child's ability to pass urine (empty the bladder) after the operation. This is because that part of the body is kept numb by the pain relieving mixture. So it is often necessary to put a tube into the bladder to drain the urine. This will be done whilst your child is asleep during the operation and is often needed because of the type of operation as well. It will be left in while the epidural continues.

How long will my child require an epidural?

The length of time depends on the type of operation and the amount of pain your child has. The epidural is usually taken out after 2-5 days as the pain settles and your child starts to eat and drink. Your child can then take milder pain relief by mouth.

Your child's anaesthetist/doctor and/or the Acute Pain service will review your child daily, checking that your child is comfortable. If for any reason the epidural does not give good pain relief to your child, an alternative plan for analgesia will be made.

There is a small risk of getting an infection after an epidural, so it is usual to take it out as soon as it is no longer needed, or if your child develops a high temperature.

What will my child feel?

When your child is waking up from the operation they may feel the tape and plastic dressing on their back that is holding the epidural catheter in place. This is not painful but may feel strange when they first start moving around.

Your child will also have a drip in their vein (Intravenous cannula- IV) and a tube in the bladder when they wake up. These are usually put in while your child is under anaesthetic (asleep) having the operation. None of this is painful, but may feel strange when they first wake up.

If the epidural is working well, your child will feel no pain in the area of their operation. Your child will be checked regularly by the nurses but please let the nurses and doctors know if your child has any pain or other problems.

Your child may notice some numbness to touch and cold, or that one or both legs feel 'heavy' or they may feel sleepy. Reassure that this is normal.

Other effects such as itchy skin, feeling sick or vomiting can be managed easily with other medicines.

What happens when the epidural is stopped?

Depending on the pain relieving drugs used the epidural's effects may take a few hours to gradually wear off. During this time your doctor will start other pain relieving drugs for your child, usually by mouth.

The tape over the epidural catheter will be removed. This may sting, like removing a bandaid. The epidural catheter is then pulled out gently, usually without any pain. At this time your child's doctor will decide when the IV drip and the tube in the bladder can come out.

Your child's pain and progress will continue to be checked by the nurses and your doctor.

• If at any time you are concerned about your child's pain please tell a nurse or doctor.