PACU Neuraxial and Regional Guidelines - Stanford University
PACU Neuraxial and Regional Guidelines
|LUMBAR EPIDURAL (1/8th% Bupiv / Dilaudid) |
|Low Abd Surgery |Lower Extremity Surgery |Thoracic Surgery |
|4-8 cc/hr / 0.2 mg/hr |4-6 cc/hr / 0.2 mg/hr |No local / 0.2 mg/hr |
|+ Fentanyl PCEA 25 mcg q10min | |
|Pts>75yo should receive less opioid (0.05-0.1mg/hr dilaudid) |
|THORACIC (T7-T10) EPIDURAL (1/8th% Bupiv / Dilaudid) |
|6 cc/hr / 0.2mg/hr |
|+ Fentanyl PCEA 25 mcg q10min |
|Pts>75yo should receive less opioid (0.05-0.1mg/hr dilaudid) |
|Peripheral Nerve Block Catheters |
|INTERSCALENE |1/8th% Bupivicaine @ 8 cc/hr |
|SUPRACLAVICULAR | |
|FEMORAL | |
|LUMBAR PLEXUS | |
|InfraClavicular | |
|Popliteal | |
|Paravertebral |1/8th% Bupivicaine @ 12-14 cc/hr |
|Use “vital signs”, “Notify MD”, & “Nursing” orders from set & add Bupiv order separately. |
| + order PCA for all patients with a peripheral catheter (unless 1’ team has done so) |
Troubleshooting Epidurals: “Do not let a non-functioning catheter go to floor!”
Epidural MUST: cover incision @ stable infusion w/o hypotention & frequent need for IVF bolus
• If no level (not used intra-op) - give 3-5cc bolus 1-2% lidocaine & recheck level
• If suspect intravascular give lidocaine w/ epi.
• If one sided, pull back 2cm and rebolus
• If still ineffective, consider removing & replacing epidural or removing & starting PCA
• If late arrival, consult w/ Pain team & consider holding LA & running opioid only.
Where to find order sets:
Epidurals: “IP PAI EPIDURAL ANALGESIA POSTOP”
Peripheral Nerve Block: “IP PAI PERIPHERAL NERVE CATHETER/REGIONAL …”
PCA: “IP PAI PATIENT CONTROLLED ANALGESIA(PCA)”
How to ADD pts to Pain list:
Must have pt in “patient list”, then right click and add:
• Treatment provider = “TT PAIN CONSULT TEAM” ( This may change soon
• Relationship = “Consulting Service”
Phones & Pagers
Pain Resident: 2PAIN (27246) (pager)
Pain Fellow: 27150 (pager), 4-6836 (phone)
Regional resident: 1-6276 (phone)
PACU: 3-6631
CVICU: 4-2829
MICU: 4-8820
SICU: 5-3234
Compiled by Mike Charles
10/2010
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