Prescriber's
Guidelines -
(con't)
These guidelines were developed for the use by Stony Brook University
Hospital’s Acute Pain Service.
TROUBLESHOOTING EPIDURALS
Ineffective Analgesia
First ask where is the pain? If outside the area of coverage, consider
Rofecoxib, Celecoxib, Ketorolac. NARCOTICS ARE LAST CHOICE BUT MAY BE GIVEN.
If pain within area of coverage: 1. Check level 2. Check catheter site—If
you think it’s in, BOLUS with Bupivacaine. MONITOR vitals every 15
minutes x 2. If successful, increase the rate by 1-2 increments. If you think it
may have migrated—BOLUS with Lidocaine. If successful and no migration, increase
rate and consider small bolus of bupivacaine. If not successful—discontinue
infusion but removal of catheter is dependent on coagulation status. REPLACE
WITH APPROPRIATE OPIOID ANALGESIA (po or PCA)
