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- CommentAuthorgadelrab.rita
- CommentTimeAug 24th 2009
I received an email from one of our members , the content is below
( I have been using post operative epidural infusions following Total Knee Replacement Surgery in certain selected patients. E.g. In very Obese patients or those with certain medical problems. There has been recent changes to our Trust Policy on Epidural Analgesia which precludes such infusions in all orthopaedic patients which is of some concern to me as I am of the opinion that epidural infusions may have a place in certain selected patients . )
I would value your opinion on this matter .
I did not get any more information but I promised to get feedback from our members
Do you have any views ?? -
- CommentAuthoremmett.chris
- CommentTimeAug 28th 2009 edited
I am puzzled as to your 'trust policy' . The policy on specialised clinical proceedures such as this is not made by a faceless committee but hopefully by a department consensus or agreement. It may be that ward nurses have a fear of any tube apart from an iv cannula in the hand and a catheter which is the c ause of the trouble.
In our department we find there is rarely a need for an epidural in knee replacement as nerve blocks have at least as high a success rate as an epidural when you take into account the perverse ability of the ward to make an epidural fail.
However we would be appalled at the suggestion that an epidural may be in some way against 'trust policy' what does the 'trust' know of an individual patient- that is what you are employed to do - make a clinical decision and using your experience and expertise do the best for the patient, unless your approach and practise is bizarre , in which case all bets are off.
Femoral nerve sheath catheters are pretty useful,and on the whole, obesity is no bar to a good nerve block -
- CommentAuthorwijesurendra.ind
- CommentTimeAug 29th 2009
Thank you for your comments on the above topic.
Epidural Trust Policy was initiated by the Consultant Anaesthetist in charge of the Acute Pain Service. Unfortunately the procedure adopted before this policy was finalised was flawed in that it was not discussed with the other consultant anaesthetists at departmental level. The reason given for the above recommendation was the lack of trained nurses on the orthopaedic wards and not having sufficient number of epidurals to maintain the skill in those who are trained.
At a personal level, in my practice, I sometimes use a combined spinal/epidural for surgery and in certain patients tend to continue a low dose epidural infusion/PCEA for 12 -48 hrs post operatively and I found this technique useful. Whilst I accept that there are other techniques available, my concern is not having the facility to use an epidural when needed. I also would like to know whether using an Epidural infusion post operatively is acceptable as a form of post operative analgesia.
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