1. Anatomy

2. 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.

3. 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.

4. Indications

5. 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.

6. -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.

7. Contraindication

8. Absolute -Infection -Patient refusal -Bleeding disorder -Hypovolemia
-Increased ICP
-Sever Aor. Mit. stenosis

9. Relative
-Sepsis
-Uncooperative pt.
-Severe spinal deformity

10. Controversial
-Pr. Back surgery
-Complicated surgery

11. Complication

12. -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

13. -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 hours
*Treatment: Bed rest, analgesics, caffeine, IV or oral hydration Epidural blood patch.

14. -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