Episode Notes: Visit SuperNurse.ai for AI-powered nursing education, interactive tools, and resources on this topic.
What You’ll Learn
Why neuraxial analgesia is increasingly used on med-surg for post-op pain and ERAS recovery pathways
Why over 80% of post-op patients report inadequate pain relief and how multimodal pain management addresses it
How neuraxial analgesia improves recovery by reducing systemic opioid side effects and supporting earlier mobilization
Neuraxial Analgesia Basics
Neuraxial analgesia delivers medication into the space around the spinal cord to block pain signals before they reach the brain
Epidural
Catheter placed in the epidural space outside the dura
Continuous infusion or intermittent dosing for ongoing post-op pain control
Common medication combination: local anesthetic (bupivacaine) plus opioid (fentanyl)
Used frequently after major thoracic and abdominal surgery
Spinal block
Single injection into the subarachnoid space, mixing with cerebrospinal fluid
Fast onset within minutes, shorter duration (often 1 to 4 hours)
Med-surg focus is usually epidural management for ongoing post-op pain
Why It’s Used
Neuraxial analgesia targets pain at the nerve roots instead of flooding the whole body with IV opioids
Benefits: better breathing, more alert patients, earlier return of gut function, earlier mobility, fewer complications, and shorter length of stay
Not one-size-fits-all: peripheral nerve blocks may be better for some lower-extremity surgeries with fewer urinary retention issues
Neuraxial analgesia is an adjunct within multimodal pain control: acetaminophen and NSAIDs may still be needed
The Med-Surg Nurse Role: Safety and Vigilance
Before the block is placed
Screen for contraindications:
Infection at the site
Major spinal deformities
Coagulopathy or anticoagulant use
Ensure readiness:
Strong IV access
Emergency equipment available
After the epidural is running: Monitoring priorities
Vital signs
Every 15 to 30 minutes initially, then hourly, then every 1 to 4 hours per policy and stability
Most common side effect to watch for: hypotension from sympathetic blockade and vasodilation
Typical responses: elevate legs, rapid IV fluid bolus, vasopressor such as ephedrine if needed
Block assessment every 1 to 2 hours
Effectiveness: pain score and comfort
Spread: ensure the block is not rising too high
Sensory level: dermatome testing
Use ice or an alcohol wipe to identify where sensation changes
This identifies the upper level of the block and helps detect unsafe spread
Motor function: Bromage scale
Used to assess motor weakness from the block
Red flag: dense block with significant weakness or paralysis
If high Bromage score suggests excessive motor block, notify provider and anticipate rate adjustment
Bladder monitoring
Urinary retention is common due to blocked nerves controlling the bladder
Monitor output, use bladder scanning if needed, and catheterize per protocol
Site assessment every shift
Check for redness, leakage, and signs of infection
High-Yield Complications and Red Flags
Post-dural puncture headache
Positional headache: dramatically worse sitting up, improves when lying flat
Initial management: hydration and caffeine
Some patients may require a blood patch
Epidural hematoma: surgical emergency
Sudden severe back pain followed by new leg weakness or numbness
Immediate action: stop infusion, notify provider, emergency MRI, prepare for decompression
Key principle: time matters for spinal cord outcomes
High block and toxicity concerns
If the block spreads too high, watch for respiratory depression and sudden sedation
LAST symptoms discussed: metallic taste, ringing in the ears, seizures
Immediate action: stop infusion, support airway, breathing, and circulation, and escalate for urgent help
Patient Education: What Nurses Must Teach
Reduce fear and anxiety by correcting myths: neuraxial analgesia is not spinal surgery
Teach using simple language and analogies, like numbing medicine near the spine
Use teach-back: have the patient explain what they would do if legs feel heavy or if they cannot urinate
Use visual aids and written materials for better retention
Tailor teaching:
Older adults: emphasize fall risk
Non-English speakers: use professional interpreters, not family
Discharge checklist: report leg weakness, inability to urinate, severe headache, fever, or new neurological symptoms
Clinical Takeaway
Neuraxial analgesia is becoming standard in opioid-sparing post-op care. Med-surg nurses succeed by mastering precise neurological and hemodynamic monitoring and delivering patient education that turns the patient into an active safety partner.
Final “Think Like a Nurse” Pearl
Chronic post-surgical pain lasting 6 months or more affects about 7% of patients, and early post-op pain control is linked to long-term outcomes. Your monitoring today can influence a patient’s quality of life for years.
Episode Notes: Visit SuperNurse.ai for AI-powered nursing education, interactive tools, and resources on this topic.
