Nursing Care of the Patient With Epidural Analgesia

Although nurses frequently are responsible to care for and ensure safety of patients receiving epidural analgesia resources to guide them in this care are difficult to locate and not inclusive of all aspects of such care. The purpose of this manuscript is to provide a comprehensive resource to provide information for nurses when caring for patients receiving analgesia via an epidural catheter.

Literature and guidelines were reviewed to determine current standards of practice and guidance regarding care of patients receiving epidural analgesia. State boards of nursing were contacted to ascertain positions regarding nursing care of thosepatients.

In 2023 the American Society for Pain Management Nursing (ASPMN) reaffirmed their 2007 position that management of analgesia by catheter techniques is within the registered nurse's scope of practice. Other professional organizations and agencies provide education regarding various aspects and factors involved in the care of patients receiving analgesia via an epidural catheter.

The literature and professional positions were identified and collated to produce a single document with evidence informed information to provide a single resource for nurses in all aspects of care of patients receiving analgesia via an epidural catheter.

To ensure patient safety, RNs need to have didactic knowledge with annual competencies as well as practical training. Education of nurses who are caring for patients with epidural catheters should include anatomy; indications and contraindications for epidural analgesia; nursing responsibility during placement of the epidural; management of the catheter after placement including monitoring, assessment for side effects, and medications used; and knowledge of potential complications and their treatment. Depending on the nurses' role the practical instruction may include ACLS, administration of anxiolytics or opioids, and/or the treatment of local anesthetic systemic toxicity (LAST). Institutional policies and procedures as well as the state description of nurses' scope of practice must define the education required of the nurses who are taking care of patients with epidural analgesia.