Epidural

Anesthesia
Grace G. Enriquez, MD, DPBA
 Anato my
The skin.
Subcutaneous fat.
The supraspinous ligament.
The interspinous ligament
ligamentum flavum
The epidural space
Physiologic Effects
 Circulation o Sympathetic blockade,
Venodilatation,
Hypotension
o Myocardial depressant effects because of large doses o Reduced
Venous thrombosis and subsequent pulmonary embolism

Respiration
o Decreased cough
Physiologic Effects
 Visceral Effects
o Bladder
Atony
Increased Sphincter tone
Urinary retention o Intestine
Increased Peristalsis
Physiologic Effects
 Renal
o Urinary production usually unaffected unless hypotension ensues

Neuroendocrine
o Neural component of stress response is blocked

Thermoregulation
o Vasodilation of lower extremities predisposes to hypothermia
Action of Anesthetics
Loci of action oSpinal
nerve roots oDorsal root
ganglia oPeriphery of
spinal cord
Action of Anesthetics
 ONSET slower than spinal
anesthesia
Less intensity of motor and sensory
block
Anesthesia develops in segmental
manner and therefore selective
blockade is possible
Indications
 Operations below the umbilicus
Older patients and those with systemic disease
Trauma if they have been adequately resuscitated
and are not hypovolaemic.
OB and Gyne cases not on NPO
Caesarean section.
Contraindications
 Inadequate resuscitative drugs
and equipment.
Clotting disorders.
Hypovolaemia
Patient refusal.
Contraindications
 Uncooperative patients.
Septicaemia.
Anatomical deformities
Neurological disease.
Reluctant surgeon.
Advantages
 Cost.
Patient satisfaction.
Respiratory disease.
Patent airway.
Diabetic patients.
Advantages
 Muscle relaxation
Bleeding
Splanchnic blood flow
Visceral tone
Coagulation
Disadvantages
 Longer induction time for the inexperienced

Difficulty locating epidural space.

High spinal

Anxiety in awake patients

Infection

Spinal headache
 Local Anaesthetics for
Epidural Anaesthesia.
Bupivacaine (Sensorcaine) 0.25%,
0.5%, 0.75%
Ropivacaine (Naropin) 2 mg/ml, 7.5
mg/ml, 10 mg/ml
Lidocaine 2% preservative -free
solution
 Lumbar puncture is
most easily
performed when
there is maximum
flexion of the
lumbar spine (fig
2).
Position of Patient
Procedure
 G 17 or G18 TUOHY Needle and G 20 epidural
catheter
 Approaches:
o Midline
o Paramedian
Procedure
Procedure
 Needle
Placement o
Loss of resistance
technique
o Hanging drop
technique
Movie
Acute Complications
 Dural Puncture
Catheter complications
Cannulation of subdural
space
Unintentional subarachnoid
injection
Acute Complications
 Intravascular injection
Local anesthetic
overdose
Direct spinal cord injury
Bloody tap
 Post-Op Complications
Spinal Headache
Backache
Urinary retention
Neurologic impairment
Infection, Epidural abscess and meningitis
Epidural hematoma