PACU Neuraxial and Regional Guidelines



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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