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Epidural anesthesia & analgesia
Epidural anesthesia involves injecting local anesthetics into the epidural space to block nerve conduction and is used widely for various applications, including surgical anesthesia and pain management. It differs from spinal anesthesia in terms of injection site, onset of action, and density of the block. Potential complications include backache, headache, urinary retention, and risk of severe neurological issues.
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Epidural anesthesia & analgesia
- 2. Epidural Anesthesia/Analgesia Localanaesthetic solutions are deposited in the epidural space between the Dura mater and the periosteum lining the vertebral canal. The epidural space contains adipose tissue, lymphatics and blood vessels. The injected local anaesthetic solution produces analgesia by blocking conduction at the intradural spinal nerve roots. 2
- 3. Wide application Epiduralblock can be performed at the sacral(caudal), lumbar, thoracic or cervical levels. Epidural techniques are widely used for operative anesthesia, obstetric analgesia, postoperative pain control, and chronic pain management. Dose judgment could be single shot, intermittent bolus or continuous infusion or combined.
- 4. Epidural Anesthesia Indication andContraindication: the same of spinal anaesthesia. Additional indication is the post operative Paine management using the epidural catheter technique. Complications: the same of spinal anaesthesia, except the post dural puncture headache. 4
- 5. 5 Differences between Spinaland Epidural Anesthesia Spinal anaesthesia Extradural Anaesthesia Level: below L1/L2, where the spinal cord ends Level: at any level of the vertebral column. Injection: subarachnoid space i.e. puncture of the Dura mater Injection: epidural space (between Ligamentum flavum and dura mater) i.e without puncture of the dura mater Identification of the subarachnoid space: When CSF appears Identification of the Epidural space: Using the Loss of Resistance technique. Dose: 2.5- 3.5 ml bupivacaine 0.5% heavy Dose: 15- 20 ml bupivacaine 0.5% Onset of action: rapid (2-5 min) Onset of action: slow (15-20 min) Density of block: more dense Density of block: less dense Hypotension: rapid Hypotension: slow Headache: is a probably complication Headache: is not a probable.
- 6. Differential block: Byusing relatively dilute concentrations of local anesthetic combined with an opiate, an epidural can block the smaller sympathetic and sensory fibers wile sparing the larger motor fibers.
- 7. Segmental block: Dueto local anesthetic is not spread readily in CSF as spinal anesthesia, a well-defined band of anesthesia at certain nerve roots without those above and below blocked can be achieved with epidural techniques.
- 8. 8 Epidural Anesthesia continue Technique: Loss of resistance technique to identify the epidural space. 0.5% Bupivacaine (mainly) or lidocaine (2.0%) is usually used to produce epidural anaesthesia.
- 9. Technique 1)Position 2)Cleaning & Draping 3)LocalInfiltration 4)Loss f Resistance Test 5)Catheter –in-situ 6)Fixing
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- 20. Advantages in conjugation withGA CV systems: Blockade of cardiac sympathetic innervation (arise atT1-T4) with dilute local anesthetic postoperatively via a thoracic epidural catheter can reduce myocardial ischemia in patients with coronary artery disease.
- 21. Respiratory system Thoracicor upper abdominal surgery is associated with 1.decreased diaphragmatic function postoperatively from decreased phrenic nerve activity 2. decreased FRC these can lead to atelectasis and hypoxia via V/Q mismatch
- 22. Some evidencesuggests that postoperative thoracic epidural analgesia in high-risk patients can improve pulmonary outcome by decreasing the incidence of pneumonia and respiratory failure, improving oxygenation, and decreasing the duration of mechanical ventilatory support
- 23. Metabolic and endocrine system Surgical trauma produces increases in ACTH, cortisol, epinephrine, norepinephrine and vasopressin and activate RAA system. Neuraxial blockade can partially suppress (during major invasive surgery) or totally block (during lower extremity surgery) this stress response and then reduce perioperative arrhythmias and the incidence ischemia possibly. AT11 block can block adrenal pathways and blunt hyperglycemia.
- 24. Complication of neuraxial block Backache Headache Urinary retention Maternal fever Transient neurologic symptoms (TNS): back pain radiating to the legs without sensory or motor deficits, occurring after the resolution of spinal block and resolving spontaneously within several days
- 25. High ortotal spinal anesthesia Subdural injection Cardiac arrest Systemic toxicity Cauda equina syndrome & other neurologic deficits, transient or permanent Maningitis & arachnoiditis Epidural abscess Spinal & Epidural hematoma