EPIDURAL

ANAESTHESIA
 One of the advantage of epidural is that the muscle blockade can
range from none to complete and can be regulated and changed by
 Choice of drug
 Concentration of LA
 Dosage
 Level of injection
 Advantages

 Epidural techniques allow for the placement of a continuous

catheter which is especially useful for

 Cases of unpredictable duration

 Prolonged postoperative analgesia

 Chronic pain control obstetric analgesia and anaesthesia

 Epidural anaesthesia is a regional Anesthesia that blocks pain in particular
region of the body.

 The goal of an epidural is to provide analgesia or pain relief ,rather than

anaesthesia which leads to total lack of feeling.

 Epidural block the nerve impulses from the lower spinal segments.

 This results in decreased sensation in the lower half of the body.

 Anatomy

 Epidural space – from base of the skull to the coccyx.

 Distance from the skin to epidural space is 4-5 cm

 Epidural space contains loose aeriolar tissue, fat, arterial and

venous networks, lymphatics, spinal nerve roots
 Physiology

 Because epidural anaesthesia is diffusion dependent

relatively large volumes of LA are needed to achieve a block
that spans several dermatomes

 It is differential blockade
 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
 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
EPIDURAL SPACE
Hanging Drop Technique

This BY
 INDICATIONS

 All operations below diaphragm

 May be used in
 Poor risk patients
 Cardiac diseases
 Pulmonary diseases
 Metabolic disturbances
 When GA is contraindicated
 When spinal is contraindicated
 Painfull conditions including post op pain relief