Anatomy
Vertebral column The spinal cord and its nerve roots lie within the central bony canal of the vertebral column which provides them structural support and protection. The vertebral column is made up of 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae.
Epidural space Definition : potential space between the dura and ligamentum flavum. It contains nerve roots, lymphatics, blood vessels, and fatty tissue. Blood supply from single ant. Spinal art. And paired post. Spinal art.
Indications
Obstetric anaesthesia -Analgesia for women in labor and for vaginal delivery. -C/S can be performed with epidural anes. -Mobile ep. Analgesia or differential block: sensory block without motor block. Aiming not to effect the pushing ability during vaginal delivery by using low concentration of local anes.
-Post operative analgesia after major abdominal and thoracic surgery -Manegment of chronic pain disorder -In critically ill pt. as a sole anes. Tech. or combined with G.A.
Contraindication
Absolute -Infection -Patient refusal -Bleeding disorder -Hypovolemia -Increased ICP -Sever Aor. Mit. stenosis
Relative -Sepsis -Uncooperative pt. -Severe spinal deformity
Controversial -Pr. Back surgery -Complicated surgery
Complication
-Backache: localized inf. Response with reflex muscle spasm -Hypotension: sym. Block -Meningitis: inf. Or chem. -High or total spinal: acc. Intrathecal inj. pres. Hypotension bradycardia and apnea treatment support resp. and cir. -Intravascular inj. : systemic toxicity CVS , CNS symptoms
-Headache: PDPH *Incidence : 3-4% *Cause: dec. ICP CSF leak *Risk fac. :young female pregnancy cutting needle *Pres. : bilateral headache + photophopia + nausea -association with body position -onset after 12-27 hours *Treatment: Bed rest, analgesics, caffeine, IV or oral hydration. Epidural blood patch.
-Persistent neurologic deficits direct inj. Into spinal cord: -Epidural abscess * back pain + fever *treatment : AB , dec. laminectomy -Epidural hematoma *sudden onset of back pain , no fever, * same treatment