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1. EPIDURAL ANESTHESIA
BY
ROBERT IGBEDE

2. INTRODUCTION
 Anesthesia is a temporary state consisting
of unconsciousness, loss of memory, lack of
pain, and muscle relaxation.
 It can be divided into 3 parts:
 Local
 Regional (spinal and epidural) and;
 General anesthesia

3. HISTORY
 The first documented general anesthetic was
performed by Crawford W. Long in 1842
 The first public demonstration of general
anesthesia was in 1846 by William T.G.
Morton
 John Snow (1813–1858) made science out of
the art of anesthesia

4. EPIDURAL ANESTHESIA
 It is a form of regional anesthesia where an
anesthetic agent is introduced directly to the
epidural space between the fourth and fifth
lumbar vertebra
 Esters: chloroprocaine, procaine, cocaine and
tetracaine
 Amines: lidocaine, mepivacaine, prilocaine,
bupivacaine, ropivacaine

5. cc
LANDMARK IDENTIFICATION
 TUFFLER’S
 LINE

7. DIFFERENCES
SPINAL EPIDURAL
 Involved space is smaller
 Injected dose is less 1,5-3,5 ml
 Usually one-shot only
 Onset of analgesia is 5
minutes
 cause neuromuscular block
 performed below the
second lumbar vertebral
body to avoid piercing and
consequently damaging the
spinal cord.
 Involved space is larger
 Injected dose is larger 10-
20ml
 Additional injections are
available
 Onset of analgesia is 15-30
minutes
 Doesn’t cause neuromuscular
block
 may be performed anywhere
along the vertebral column

8. DIFFERENCES
 Below the anesthesia
all segments are
blocked
 Extension of block is
depended on the
density of solution and
the position of patient
 Possible to create
segmental block
 Extension of block is
depended on the
volume and rate of
injections and the
position of patient has
no impact

9. ADVERSE EFFECTS
 Hypotension and bradycardia through
blockade of the sympathetic nervous system.
 Limb damage from sensory and motor block.
 Epidural bleed
 Post-dural puncture headache
 Hypotension

10.  Respiratory failure if block is 'too high'.
 Direct nerve damage.
 Hypothermia.
 Damage to the spinal cord - may be transient or permanent.
 Spinal infection.
 Aseptic meningitis.
 Hematoma of the spinal cord - enhanced by use of LMWH
pre-operatively.
 Anaphylaxis.
 Urinary retention.
 Spinal cord infarction.
 Anesthetic intoxication

11. CONTRAINDICATION
 Patient’s refusal
 Coagulopathy
 Infection at the site of epidural injection
 Abnormal anatomy of the spinal column
 Septicemia
 Neurological disease
 Severe aortic or mitral stenosis

12. THANKYOU ALL