Vascular, Acute Pain and Thoracic Service
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| Lumbar Epidural |
| Test Dose of 3cc 1.5% Lido 1:200K epi |
| Bolus: 0.0-0.4 mg Hydromorphone (avoid for PONV prone patients) |
| GA/MAC 10-15 cc 2% Lidocaine 1:200K epi |
| PACU Assessment |
| Start Infusion within 1 hour 0.25% Bupivicaine 6-10 cc/hour (use disposable syringe pump) |
| Working Epidural Post Op Infusion Bupivicaine 0.125% 6-8 cc/hour Hydromorphone 0.1-0.2 mg/hour Fentanyl PCEA 25 mcg q 15 min |
| Post Op Mgmt Epidural till am POD 2 Lovenox start pm POD 2 Goal D/C POD 3 |
Questionable Epidural
Bolus 10 cc 1% Lidocaine
Bolus 10 cc 1% Lidocaine
- If good pain relief start infusions
- Some relief and temperature
discrimination lost over leg, use
catheter and substitute IV PCA - Replace/Manipulate or Remove
Catheter
Order Post Op Infusions (see below) through EPIC. Sign and release your orders (do not sign and hold). Pharmacy will have gtts available for your patient when you arrive in PACU. (Let someone from VATS know if this is not the case) |