The epidural space is a part of the human spine inside the spinal canal separated from the spinal cord and its surrounding cerebrospinal fluid (CSF) by a membrane called the dura mater or simply dura. Using an epidural catheter, both anesthesia (loss of feeling) and analgesia (loss of pain) can be administered. The space is also of clinical interest since its cranial part contains vessels (e.g. the middle meningeal artery) susceptible to lesions after head traumas, causing a lethal (if not treated immediately) epidural hematoma.

Epidural anesthesia is a form of local, or more specifically regional, anesthesia involving injection of drugs through a fine tube, called a catheter, which is placed into the epidural space. The epidural space is very close to the spinal cord, lying just outside the outer most membrane called the dura mater.

Most commonly, anesthesiologists place the catheter in the lumbar, or lower back region of the spine, although sometimes a catheter is placed in the thoracic, (chest) or cervical (neck) spines.
Patients getting modern epidurals generally receive a combination of local anesthetics and opioids. Common local anesthetics include lidocaine, bupivicaine and ropivicaine. Common opioids are fentanyl and pethidine. These are then injected in relatively small doses.
In epidural anesthesia, to allow surgical procedures, larger dose are given in order to remove all feeling in a large region of the body, resulting in short term paralysis.

Epidural anesthesia is a form of local, or more specifically regional, anesthesia involving injection of drugs through a fine tube, called a catheter, which is placed into the epidural space. The epidural space is very close to the spinal cord, lying just outside the outer most membrane called the dura mater.

Most commonly, anesthesiologists place the catheter in the lumbar, or lower back region of the spine, although sometimes a catheter is placed in the thoracic, (chest) or cervical (neck) spines.

Patients getting modern epidurals generally receive a combination of local anesthetics and opioids. Common local anesthetics include lidocaine, bupivicaine and ropivicaine. Common opioids are fentanyl and pethidine. These are then injected in relatively small doses.

In epidural anesthesia, to allow surgical procedures, larger dose are given in order to remove all feeling in a large region of the body, resulting in short term paralysis.

The technique
Using a strict aseptic technique a small volume of local anaesthetic, such as 1% lignocaine, is injected into the skin and interspinous ligament. A 16 or 18 gauge Tuohy needle is then inserted into the interspinous ligament and a "loss of resistance" technique is used to identify the epidural space.
Traditionally anaesthetists have used either air or saline for identifying the epidural space, depending on personal preference. However, evidence is accumulating that saline may result in more rapid and satisfactory quality of analgesia (Norman 2003).

After placement of the tip of the Tuohy needle into the epidural space the catheter is threaded through the needle. The needle is then removed. Generally the catheter is then withdrawn slightly so that 4-6 cm remains in the epidural space.

Side effects

• Confinement to bed
• Loss of ability to move around actively during labor
• Loss of sense of needing to urinate requiring placement of a urinary catheter
• Pain in the area of placement is not uncommon for up to a year after an epidural
• Increase in fetal malpositions due to confinement in bed
• Sudden drop in blood pressure

Complications include:

• Dural Puncture headache (about 1 in 100) – can be severe and last several days. It is caused by a reduction in CSF pressure and is characterised by exacerbation when the patient raises their head above the lying position. If severe it may be successfully treated with a "blood patch" (a small amount of the patient's own blood given via another epidural needle). Most cases resolve spontaneously with time.
• Block failure (about 1 in 20). Partial failure may still give satisfactory pain relief. However, if pain relief is inadequate, another epidural may have to be performed.
• Hypotension which may briefly affect baby.
• Significant damage to a single nerve (rare, less than 1:10,000).
• Paraplegia (extremely rare, less than 1:100,000).
• Death (extremely, extremely rare, less than 1:100,000).

Contraindications

• Patient refusal
• Bleeding disorder
• Infection overlying area spine to be injected.

Source: From Wikipedia, the free encyclopedia

__________________
Article Bot posts articles open for discussion.