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After an operation, a patient has been given an epidural block to manage their pain.
In this animation, the level of fluid in the bath represents the level below which the
block is effective. This corresponds to the level of the nerve
root bathed by the anaesthetic of the epidural. In the animation, any fluid added to the bath
represents additional anaesthetic from the epidural pump. The plughole represents metabolism
or redistribution of the anaesthetic. Currently, the upper level of the block is
at the T12 level. The patient can feel a cold spray above T12
but not below it. The surgical scar is at the level of T8 and
is causing pain. A bolus of the epidural is given to increase
the level of the block. This relieves the patient's pain.
To keep the block at this level, the infusion rate must be increased.
In clinical practice, we also check the lower end of the block, which may be too high.
In this example, the lower end of the block is too high
This is a rare problem and can be difficult to manage.
A bolus of the epidural is given and the infusion rate is increased, allowing the block to cover
the wound, above and below. By adding more fluid to the bath, the block
is able to spread, above and below the wound, relieving the patient's pain.