epidural anaesthesia
Oct 16, 2025
Epidural Essentials 🌿
Much like spinal anaesthesia, an epidural involves the injection of local anaesthetic, with or without an adjunct like fentanyl, near the spinal canal, in the hopes of establishing a significant block to facilitate surgery and/or provide profound analgesia.
But here’s where things are different:
An epidural uses a larger needle, which is inserted into the epidural space, between the ligamentum flavum and the dura mater of the spinal cord. The larger needle allows for the placement of a catheter, which can provide ongoing analgesia via top-up or continuous infusion, versus a single shot injection used with spinal anaesthesia.
Epidurals are probably most recognised for their use in labour analgesia ❤️ however they also provide significant benefit in surgical patients in regards to post-operative analgesia. An epidural produces a segmental block – meaning the effects of the block are felt across a segment of the body, as compared to a spinal anaesthetic that produces a profound sensory and motor block below the level of injection.
The height and coverage of this block can be manipulated by adjusting dose, volume and the level of catheter placement depending on the area requiring analgesia. For this reason, epidurals are an excellent analgesia option for patients undergoing thoracic and abdominal surgeries 🏥 where spinal anaesthesia would not safely provide a high enough block.
Insertion of an epidural requires skill to ensure correct catheter placement while avoiding dural puncture. Ongoing monitoring of an epidural by nursing staff often requires additional training and accreditation to ensure specialised knowledge and care are provided. Continuous monitoring of block spread is essential to determine ongoing analgesic effect and early detection of potential issues such as catheter migration. Removal of an epidural also requires consideration and careful timing with respect to coagulation status.
Risks associated with epidural are similar to those of spinal anaesthesia, including hypotension, catheter misplacement, patchy or failed block, dural puncture, infection or neurological complications.
In summary, although spinal and epidural anaesthesia have many similarities, it is important to recognise that they differ in many ways — from insertion and placement, to ongoing monitoring and potential side effects. Perioperative nurses caring for these patients need to understand and recognise these vital differences in order to ensure safe, high-quality care is provided.
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References:
Australian and New Zealand College of Anaesthetists. (2014). PG03(A) Guideline for the management of major regional analgesia. https://www.anzca.edu.au/getContentAsset/a70212ec-6074-4fa5‐a62b‐742f1f64523a/80feb4
37-d24d-46b8-a858-4a2a28b9b970/PG03%28A%29-Guideline-for-the-management-of-major-regional-analgesia-2014.PDF?language=en&view=1
Australian Society of Anaesthetists. (n.d.). Epidural and spinal anaesthesia and analgesia. https://asa.org.au/epidural-and-spinal-anaesthesia-and-analgesia
Rigg, J. R. A., Jamrozik, K., Myles, P. S., Silbert, B., Peyton, P., Parsons, R. W., & Collins, K. (2000). Design of the Multicenter Australian Study of Epidural Anesthesia and Analgesia in Major Surgery: The MASTER Trial. Controlled Clinical Trials, 21(3), 244-256. https://doi.org/10.1016/S0197-2456(00)00045-3
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