Some ACCU patients will have epidural infusions running. The Trust has comprehensive guidance on managing epidurals (search for ‘epidural’ on the intranet). The clinical pearls are as follows:
- If a patient has weak legs, reduce the epidural infusion. If they have profound weakness/paralysis, stop the infusion altogether and reassess. If their strength does not progressively return, consider an urgent MRI.
- If a patient has a slightly low block, try simply increasing the infusion rate by 2 mL/hr.
- If a patient has much too low a block, or a unilateral block, they probably need a bolus. Give them 5 mL in the first instance, using the pump. Monitor their blood pressure carefully for 15 minutes following the bolus. If the block is unilateral, lie the patient painful side down before administering the bolus.
- Signs of a dangerously high block include:
- Block to cold above T4
- Tingling in the fingers
- Dyspnoea
- Bradycardia
Sit the patient upright if they will tolerate this, stop the infusion immediately.
- If in any doubt, ask an anaesthetist (from on or off the unit) to review the patient.
Do not simply stop the epidural and remove it without exhausting efforts to rescue it.