EPIDURAL ANESTHESIA

How it works and where is it injected?

Epidural is used to reduce pain sensation and is particularly useful in situations where it is desirable to have the patient conscious such as during childbirth to reduce pain during labor a nerve block of the lumbar and sacral nerve roots coming off the spinal cord is necessary in most individuals the spinal cord proper ends at around the level of second lumbar vertebra a bundle of nerve roots known as the cauda equina originate from the end of spinal cord and supply the nerves to lower lumbar and sacral segments for safety’s sake.

The needles and catheters for epidural anesthesia during childbirth are typically inserted below the level of the second lumbar vertebra in area of the cauda equina in order to avoid the spinal cord. the dural covering surrounding the cauda equina and then inside of the dural covering.

the arachnoid layer the target of epidural static the epidural space lies between the dural covering and the rear most portion of the spinal canal within dura and arachnoid layers flows cerebral spinal fluid or CSF which originates from ventricles in the brain not to be confused with the ventricles of heart.

any interspace below the level of second
lumbar vertebra may be employed in an obstetric alep adoro anesthetic a long needle known as a 2e needle is first advanced into the soft tissues between the spinous processes of the fourth and fifth lumbar vertebra a syringe containing a few cc’s of saline is attached to the tui needle with the operator maintaining a light but steady pressure on the plunger of the syringe the needle and are advanced steadily through the interspace once the tip of needle is advanced into the epidural space operator notes a release of the syringe plunger as the Saline squirts into space the epidural catheter is then inserted through the TUI needle owing to a slight curve at the tip of - a needle catheter is directed upward approximately four to five centimeters into the epidural space you the tui needle is then removed to ensure that the catheter is properly placed in the epidural space and not within the dura and arachnoid coverings a syringe containing a small dose of anesthetic typically lidocaine is attached to the catheter and injected a minimum of three minutes after the test dose the patient’s ability to move their lower limb is tested if the patient is able to move their lower limb this indicates proper placement of the epidural catheter in the epidural space if the lower limb cannot be moved then placement of the catheter within dura and arachnoid layers must be assumed this is also known as an intra thecal catheter placement and required that the catheter be removed and placement procedure started over.

once proper placement of the catheter has been ascertained a bolus dose
consisting typically of about 10 cc’s anesthetic is injected through the catheter to initiate the anesthesia a continuous infusion of anesthetic is then initiated the rate of infusion may be adjusted according to the patient’s response on the level of anesthesia desired you