Epidural  Anaesthesia

In this type of anaesthesia, local anaesthetic drug is injected around the spinal cord in the epidural space. The local anaesthetic drugs block the nerves as they emerge from the vertebrae column.

An intravenous line is placed and monitoring of heart rate, electrocardiograph, blood pressure started.

Patients back is cleaned with an antiseptic solution and draping is done using sterile drapes.

Local anaesthetic drug is infiltrated under skin where epidural needle is going to be placed.

Epidural needle is inserted at L3L4 intervertebral space. Epidural space is identified by loss of resistance technique. Epidural catheter is placed through the needle and advanced up-to 3 to 4 cm into the space. The needle is removed and catheter is taped and fixed to the back of patient. A bacterial filter is attached to the injection port of the catheter. The epidural needle or catheter may accidentally enter into any blood vessels or subarachnoid space. To avoid injection of large doses of local anaesthetics in either of these spaces, test dose of containing small amount of local anaesthetics is injected. Any sensory or motor block following this dose would suggest an accidental dural puncture resulting in spinal anaesthesia. An accidental intravenous placement is identified by increase in heart rate and blood pressure within a minute of injecting the drug. In either of these situations, catheter may need to be withdrawn or replaced. If neither response is seen, correct placement of catheter is confirmed and full doses of local anaesthetics is given in divided doses. Patient is continuously monitored. 

Accidental dural puncture may lead to post dural puncture headache.



  • Meningitis
  • Urinary retention

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