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| Author | Comment |
Liz Heighton
 Feb 14, 05 - 1:57 PM |
To wean or not to wean
I am having a bit of a debate as to whether epidural infusions with opioids should be reduced slowly or switched of prior to being discontinued. I recall reading an article which suggests that there is nothing to be gained by weaning,but can't find it now!Any advice? 
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Sarah
Feb 15th, 2005 - 9:06 PM |
Re: To wean or not to wean
Hi Liz In our service we do not wean epidurals unless - the patient is over sedated, has a horners or the block level is extending above T3. I never quite understood why weaning works, say in a patient with a laparotomy, for weaning to work would'nt the top of the wound have to be healing quicker than the bottom. As for stopping the infusion - we stop them and review about 3-4 hours later. If we have no intention of restarting the infusion (if the epidural has been in for five days)we remove it when we stop it. hope this helps. I am interested in what other are currently doing. Sarah
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Liz Purser
Dec 11th, 2007 - 5:58 PM |
Re: Re: To wean or not to wean
This message is for steve who replied to your message. I noted that he uses patient controlled epidural analgesia. We are looking into using them at MRI and are after information and protocols. Thanks Liz |
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cheryl
Feb 18th, 2005 - 11:08 AM |
Re: To wean or not to wean
We don't wean either. It's out with the catheter, then onto the pain ladder. Usually after about 2 days. |
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Alyson Evans
Feb 25th, 2005 - 3:19 PM |
Re: To wean or not to wean
Like the others we don't wean. All you achieve is pain to the upper edge of the wound in laparotomy patients. |
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Jane Langley
Feb 28th, 2005 - 4:46 PM |
Re: To wean or not to wean
Our protocol is not to wean an epidural (despite the surgeons best efforts to tell the staff otherwise!). It does not make logical sense to us to only partially block the wound. There is also the added complication of replicating oral opiates with your epidural opiates if the patient then needs supplimentary analgesia. Once a decision is made that the patient can move on from the epidural, they cross to the appropriate level of the analgesic ladder. Have not come across any literature that looks at withdrawal when epidural opiates are withdrawn and have not seen it as a problem in clinical practice although this may be because they almost always require some strength of opiate as step down analgesia anyway.
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Steve
Mar 1st, 2005 - 9:26 AM |
Re: To wean or not to wean
We use PCEA which makes it easier for the nurses to assess the amount of pain the patient is experiencing, so that the hourly rate can be adjusted more appropriately and more safely, and the patients are to some degree weaning themselves. We stop all our epidurals after 48 hours (except in special circumstances) to reduce the risk of infection. As soon as the PCEA is stopped, patients are given a morphine PCA which they can use as soon as they feel pain. Alternatively they are given a titrated dose of Oramorph hourly PRN. All of our patients are given paracetamol and a NSAID regularly with the PCEA and after it has been stopped, if not contraindicated. |
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