MEDINCINE

1. OT PREPARATION FOR
EPIDURAL
ANAESTHESIA

2. DEFINITION
In this the drug (Local anesthetic) is
deposited around the nerve we need to
block
This causes the reversible loss of
autonomic, sensory and motor sensation
carried by that nerve and the area
supplied by its anesthetized.

3. EPIDURAL ANESTHESIA
The injection of local anesthetics
into areas of the body to produce
analgesia for post-operative pain
relief.
It is the method of medication
administration in which a medicine
is injected into the epidural space.

4. EPIDURAL ANATOMY

5. USES
All surgeries under spinal surgeries
Upper abdominal , thoracic neck
surgeries
Post operative management

6. EPIDURAL ANESTHESIA
Drugs used
Lignocaine- with or without adrenaline(
1-2%)
Ropivacaine(0.1-1%)
Levobupivacaine( 0.125- 0.75%)
Onset
•15-20 mins

7. EPIDURAL ANESTHESIA
Drugs used- Opioids
•Morphine-: 4-6 mg (diluted in 10 ml saline)
•Onset: within 30 min
•Duration: 12-16hrs
•Fentanyl: 100mcg( diluted in 10ml saline)
•Onset: within 10 min
•Duration: 2-3 hrs

8. EPIDURAL ANESTHESIA AND
ANALGESIA
Positioning: Sitting

9. EPIDURAL ANESTHESIA AND
ANALGESIA
Positioning: Lateral
Patient comfort and should dictate the position that patient
is placed in prior to insertion of the epidural needle.

10. FINDING THE EPIDURAL
SPACE
Loss of resistance technique
A catheter can then be inserted and a
test dose of local anesthetic is given.
The test dose consists of local
anesthetic
The anesthesiologist waits about 3
minutes after the specific drug is
injected and then examines the patient
for loss of lower limb motor function of
sensation

11. Loss of resistance technique

12. EPIDURAL NEEDLES AND
CATHETERS
Tuohy needle

13. EPIDURAL BLOCK
The technique provides a block
that causes sensory anesthesia
Pain is eliminated but sensation of
pressure or movement of the
abdominal wall are often
recognized by the patient

14. ADVANTAGES
The major advantage of this technique is
that it can be modified by increasing or
decreasing the rate of infusion of local
anesthetic through the catheter or by
changing the concentration of local
anesthetic
This technique requires a very small dose of
local anesthetic to be injected directly into
the sub arachnoid space with no catheter
This is an ideal technique for elective
cesarean sections and surgery in the lower
limbs like Total knee replacement

15. DISADVANTAGES
Accidental total spinal
Overdose and toxicity because of
the larger volume used

16. COMPLICATIONS
Hypotension
Bradycardia
seizures
Post dural puncture headache
Epidural hematoma
Infection
Epidural abscess
Urinary retention

17. TOTAL SPINAL
A completely reversible dreaded
complication of epidural anesthesia
It will cause complete blockade of all the
spinal nerves and sometimes the cranial
nerves

18. COMBINED SPINAL
EPIDURAL

20. NEEDLE THROUGH
NEEDLE TECHNIQUE

21. BENEFITS
Rapid onset of action(SA)
Good block and good muscle
relaxation(SA)
Spread of anesthesia is optimized,
anesthesia can be prolonged (EA)
Post-operative analgesia can be
achieved (via EA)

22. INDICATIONS
Obstetrics( Cesarean section)
Gynecologic surgery
Orthopedic surgery
Urologic surgery

23. OPTIONS FOR CSE
TECHNIQUE
Double needle (Needle Through
Needle)- Single Interspaces
Double catheter (Catheters in epidural
and subarachnoid space)
Double needle – separate interspaces
Double needle (Needle beside needle)-
single interspaces