• Reference Number: HEY384/2025
• Departments: Pain Medicine
• Last Updated: 30 April 2025

Introduction

This leaflet has been produced to give you information about a method of pain relief known as Patient Controlled Epidural Analgesia (PCEA), which is used after major surgery. It describes what happens when you have an epidural, together with any side effects and complications that can occur. Whilst you have a PCEA your care will be reviewed daily by a member of the acute pain team (not on a weekend). This is to ensure you are getting the best results from your pain relief.

If after reading this leaflet, you have any concerns or require further explanation or advice on your pain relief options, please discuss this with a member of the healthcare team.

What is Patient Controlled Epidural Analgesia?

An epidural involves injecting local anaesthetic through a fine plastic tube, called an epidural catheter, into the epidural space (near your spinal cord). This causes the nerve messages to be blocked, and therefore relieves pain.

The epidural pump allows local anaesthetic to be given continuously and/or as an extra dose by pressing a button. This will depend on how the pump is programmed. Whilst you have a PCEA, you can still take other pain-relieving drugs.

What are the benefits?

After an operation, it is important that you are able to move around and return to normal activities as soon as possible. PCEA usually provides better pain relief than most other methods, particularly when you move. This reduces the risk of complications after major surgery such as nausea/vomiting, blood clots in the leg and lung, chest infection and delayed bowel function. You should experience a quicker return to eating, drinking and full movement, possibly with a shorter stay in hospital compared to other methods of pain relief.

What happens during the procedure

Epidurals can be put in when you are awake, when you are sedated (drugs are given to make you feel sleepy and relaxed) or during an anaesthetic. These choices can be discussed further with your anesthetist.

• A needle will be used to put a short, thin plastic tube (a cannula) into a vein in your hand or arm for giving fluids (a drip).
• If you are conscious, you will be asked to sit up or lie on your side, bending forwards to curve your back.
• Local anaesthetic is injected into a small area of the skin where the epidural will be inserted
• A special epidural needle is pushed through this numb area, and a long thin plastic tube (catheter) is passed through the needle into your epidural space. The needle is then removed, leaving only the catheter in your back.

The local anaesthetic may sting briefly when it is injected into your skin.  You may feel slight discomfort in your back as the catheter is inserted, as well as some pressure and pushing.

• Occasionally an electric shock like sensation or pain occurs during needle or catheter insertion. If this happens you must tell your anesthetist immediately.
• A sensation of warmth and numbness gradually develops and your legs may feel heavy and become increasingly difficult to move.
• You may only notice these effects for the first time when you recover consciousness after your operation, particularly if the epidural was put in when you were anaesthetised

Blood Thinning Drugs

It is really important to inform your medical, nursing and anaesthetic team if you are taking any blood thinning medications. These can include anti coagulants (ie. warfarin, apixaban, edoxaban, rivaroxaban and dabigatran) or antiplatelet medications (clopidogrel, ticagrelor and high dose aspirin). If you are pre assessed you will be advised when you should stop taking them. These medications will be restarted after the epidural is removed. You may be given blood thinning injections before and after your operation whilst you’re not taking your usual tablets.

Possible side effects and risks

All the side effects and complications described can occur without an epidural. Common side effects are often minor and usually easy to treat. Serious side effects are fortunately rare. The risk of complications should be balanced against the benefits and compared with alternative methods of pain relief. Your anaesthetist can help you do this.

• Inability to Pass Urine

The epidural affects the nerves that supply the bladder, so you will usually have a urinary catheter to drain your bladder. This is often done routinely after major surgery as the urine output reflects the function of the heart and the kidneys. . Your bladder function returns to normal when the epidural wears off.

• Low Blood Pressure

As the local anaesthetic affects the nerves going to your blood vessels, blood pressure always drops a little.  Fluids and or drugs can be put into your drip to treat this. Low blood pressure is common after surgery, even without an epidural.

• (Pruritis)

This can occur as a side effect of Morphine like drugs used in combination with local anaesthetic. It can be easily treated with anti-allergy drugs.

• Feeling Sick and Vomiting

These can be treated with an anti-sickness drug, however this is less of a problem with an epidural than with most other methods of pain relief.

• Backache

This is common after surgery, with or without an epidural, and is often caused by lying on a firm flat operating table.

• Inadequate Pain Relief

Sometimes, it may be difficult to place the epidural catheter, and the local anaesthetic may not spread adequately to cover the whole operation site.

Overall, epidurals usually provide better pain relief than other techniques. If your epidural is not working properly, the epidural catheter will be removed, and an alternative method of pain relief will be commenced.

• Weak or Numb Legs

The local anaesthetic can affect the nerves supplying your muscles resulting in weakness. This means that you will not be able to walk or move around easily. The nurse will adjust the epidural so that the numbness or weakness is minimal enabling you to move around. The nurse will check the movement in your legs regularly by asking you to bend your knees.

How to use the pump

Usually, you will have a continuous infusion of pain relief through your epidural. You may have a handset, where you can give yourself an extra dose if you are in pain. This is by pressing the button on the handset when it is green. The green light will flash while you are being given the dose. The pump will then lock you out for 30 minutes, meaning even if you try press the button, you will not receive any medication. If your pain is still not controlled, please speak to your nurse.

What happens afterwards?

At regular intervals the nurses will ask you about your pain and how you are feeling.  They will observe your breathing, pulse, blood pressure and check that you’re able to move your legs. They may adjust the epidural pump and treat any side effects.

They will check that the pump is functioning correctly. They will encourage you to move, eat and drink (according to your surgeon’s instructions). The Acute pain Nurses will visit you daily (except on weekends); to ensure you are getting the most from your pain relief. The epidural will be reviewed every day and will be stopped when you no longer need it for pain relief. This is usually when you are taking oral pain relief and can comfortably cough, deep breath and mobilise. The epidural may be kept for 2-5 days.

 Should you require further advice on the issues contained in this leaflet, please speak to your medical and nursing team, who can refer to the acute pain service if required.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.