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Epidural/intrathecal analgesia

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Definitions

Epidural analgesia is the delivery of analgesia via a catheter placed in the epidural space of the spinal column. Intrathecal analgesia is the delivery of analgesia into the cerebrospinal fluid of the subarachnoid space. These guidelines refer to epidural analgesia. Modifications for intrathecal analgesia are highlighted below. N.B. The procedure should only be carried out by an anaesthetist.

Indications

At St Christopher’s Hospice epidural analgesia is presently only indicated for the palliative management of abdominal, chest wall, back, hip or pelvic pain in malignant disease (de Leon-Casasola et al, 1994).

Contraindications

  • ▶▶ The patient has an uncorrectable coagulopathy (defect in the blood-clotting mechanism)

  • ▶▶ The patient is septic

  • ▶▶ The patient has a pressure ulcer close to the proposed site of insertion …

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