5.6 Epidural analgesia
Epidural analgesia provides excellent pain management after major surgery. It is only safe
to use on wards with trained staff under pain service supervision. Usually, a combined
local anesthetic and opiate infusion is used. These drugs act synergistically, but can be
given separately. The level and density of block must be regularly assessed. Ideally, the
local anesthetic will provide blockade of small nerve fibers (pain and temperature) but
maintain fine sensation and motor power. The opiates augment the analgesic effect at
spinal level.