Epidural Catheter

What is it?

An epidural catheter is a thin, flexible tube placed in the epidural space, which lies just outside the membrane (dura) that surrounds the spinal cord. Through this tube, pain medicines can be delivered directly and continuously to the area where nerves leave the spinal cord. The aim is to control pain with much lower doses than those taken by mouth or given into a vein.

Epidural catheters are also widely used during childbirth and after major surgery. This page explains their use in cancer pain and palliative care, which focuses on comfort and quality of life. Most cancer pain can be controlled with medicines; an epidural catheter is considered for selected patients when that approach is not enough.

When is it considered?

An epidural catheter may be considered when pain is not adequately controlled despite regular, appropriate use of strong painkillers, or when side effects prevent the dose from being increased. It is particularly suited to pain concentrated in one area, such as the chest wall, abdomen, pelvis or legs.

How long treatment is likely to be needed also matters. An epidural catheter can suit shorter-term needs. When treatment is expected to last weeks or months, intrathecal systems that deliver medicine directly into the cerebrospinal fluid, such as an intrathecal port, are usually preferred: much lower doses are needed and catheter problems are less common.

International cancer pain guidelines recommend that spinal drug delivery be included in cancer pain management, provided it is carried out and monitored by an experienced team. The decision is based on the type and spread of the pain, imaging findings, overall health and the support available at home.

How does it work?

Medicines given into the epidural space act close to the structures that carry pain signals in the spinal cord. A low dose of an opioid (a morphine-type painkiller) is usually combined with a local anaesthetic. The local anaesthetic dampens pain signals from a particular region, while the opioid acts on receptors in the spinal cord.

Because the medicine reaches its target directly, side effects linked to high oral doses, such as drowsiness, constipation and confusion, are expected to lessen. The catheter is connected to a portable pump that delivers a continuous dose and can often be set to allow extra doses within safe limits when pain increases.

Before the procedure

Recent scans are reviewed to assess how the tumour relates to the spine and spinal canal. Clotting tests and the platelet count are checked. When to stop and restart any blood thinners is planned carefully, with bleeding risk in mind.

This treatment is a team effort. The oncology, palliative care and, where needed, home care teams are involved. Who will look after the pump, and whom to contact if a problem arises, are agreed before the procedure. You and your family will be told about its aims, possible risks and the alternatives before you give consent.

What happens during the procedure?

The procedure is carried out under sterile conditions. You lie on your side or sit leaning forward. The skin is cleaned and the needle path is numbed with local anaesthetic, with light sedation if needed. A special needle is guided into the epidural space, the thin catheter is threaded through it and the needle is removed. Where needed, the catheter position is confirmed with fluoroscopy (live X-ray).

If longer-term use is planned, the catheter is passed through a short tunnel under the skin so that it comes out on the side or front of the body. This helps reduce the risk of infection and of the catheter slipping out. The catheter is then secured with a dressing and connected to the pump.

After the procedure

In the first hours, blood pressure, breathing, drowsiness, and sensation and strength in the legs are checked regularly. The dose is adjusted over the next few days according to pain and side effects. Opioids taken by mouth are usually not stopped abruptly but reduced gradually to avoid withdrawal symptoms.

If you are going home, your family or a home care nurse will be shown how to look after the catheter and pump. Keeping the entry site clean and dry, changing the dressing under sterile conditions and checking the pump regularly are all important.

When might you notice results?

Pain often eases soon after the medicine is started. Finding the right dose may take a few days, however, and the dose may need adjusting over time as the illness changes.

Results vary from person to person. An epidural catheter does not always remove pain completely; the aim is to improve quality of life while keeping side effects acceptable. For pain arising from upper abdominal organs such as the pancreas, sympathetic nerve blocks are also among the options. To discuss the right approach for you, you can request a consultation.