1. EPIDURAL ANESTHESIA

2. EPIDURAL ANESTHESIA
Epidural anesthesia is a regional anesthesia that blocks pain in a particular region of the body
The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.

3. EPIDURAL ANESTHESIA Anatomy
Epidural space – base of skull (foramen magnum) to the coccyx (sacrococcygeal membrane)
Distance from skin to epidural space – 4-5 cm
Epidural space contains loose areolar tissue, fat, arterial and venous networks, lymphatics, spinal nerve roots
LA deposited in epidural space
Block spinal nerve roots that traverse peridural space
Blocks sympathetic nerves traveling with the anterior roots
Applications range from sensory analgesia, minimal motor block, or dense anesthesia and full motor block – controlled by drug choice, concentration, dosage

4. Types – selective blockade possible because it can be performed at any level of spine
Cervical epidural
Thoracic epidural
Lumbar epidural
Caudal epidural
Factors Influencing Spread of Solution
Height of patient
Drugs used
Volume
Concentration
Level of puncture and catheter insertion

5. Technique Method Position Single dose injection
Fractional – continuous epidural – repeated injections of LA through catheter inserted into epidural space
Position
Cervical epidural – sitting (C7)
Thoracic epidural (T7)
Lumbar epidural
(L1-L2, L2-L3, L3-L4, L4-L5)
Lateral Decubitus, full flexion

8. Method of Identifying Epidural Space
Principle: negative pressure in space
Loss of resistance
Plunger of syringe pushed without resistance once epidural needle is in
Hanging Drop
Drop of saline at hub of epidural needle is sucked in once it enters space

10. Indications All operations below diaphragm May be used in
Poor risk patients
Cardiac diseases
Pulmonary diseases
Metabolic disturbances
When GA is contraindicated
When spinal anesthesia is contraindicated
Painful conditions including post-op pain relief

11. Contraindications – similar to spinal
Severe hemorrhage
Coagulation defects
Previous laminectomy
Uncooperative / apprehensive
Local inflammation at site
Patient refusal
Advantages
Well-defined area of anesthesia
Longer duration
More severe disturbances of spinal anesthesia minimized
GI complaints minimized
Catheterization minimized
Less respiratory effects

12. Disadvantages Physiologic Effects Drugs: low-dose LA, opiods
Technically more difficult
Muscle relaxation not complete
Large volume necessary
Danger of dural puncture
Incomplete / patchy block
Physiologic Effects
Similar to those observed in spinal anesthesia
Slower onset
Less intensity of motor and sensory block
Drugs: low-dose LA, opiods

13. Epidural anathesia
Spinal anathesia
Site of injection
In the epidural space
Subarachnoid space
Onset and duration
Slow onset and continous duration (use catheter)
Rapid onset and limited duration
advantages
Can be used in analgesia
Not used
Needle dose
Curved,longand blunt (touhy) 10_30ml
Small and sharp 1_4ml
space
Any space usually lumber
lumber
Quality of sensory and motor nerve block
less
More liable
toxicity
Hypotention gradual total spinal +++ systemic toxicity +++
Sudden + +

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