1. epidural anesthesia during labor by: Asmaa Mashhour Eid supervised: Dr Aida Abd El -Razek

2. Objective 1- Anatomy of epidural space 2- definition of epidural anesthesia during labor 3- explain indication of epidural 4- list contraindications 5- Described positions epidural anesthesia and timing

3. 6-list technique for administration before and after given 7- list advantages 8- list disadvantages 9-summarzd 10- reference

4. Anatomy of epidural space the nerves in the spinal cord are protected by several tissue layers the pia mater is the membrans adhering to the nerves fiber surrounding this is the cerebrospinal fluid (csf) next comes the arachniod membrans and outside that tha dura mater

6. Definition anesthetic agent placed in the epidural space at the L4-L5 or L3-L4 interspace block spinal nerve root and sympathetic nerve fiber

7. Indications Relief from the pain of uterine contractions and birth during laber

8. Contraindications to epidural block 1.Active antepartum hemorrhage (Acute hypovolemia leads to increased sympathetic tone to maintain the blood pressure, any anesthetic technique the blocks the sympathetic fiber can produce significant hypotension that can endanger the mother and baby

9. 2.Anticoagulant therapy or bleeding disorder 3.Infection at the injection site infection can be spread through the peridural or subarachnoid spaces if the needle traverses an infected area 4.Allergy to the anesthetic drug 5.maternal refusal

10. positions epidural anesthesia and timing between L4-L5 or L3-L4 when the cervix is dilataed 5 to 6 cm

12. Technique for Administration before 1- cervix is dilataed 5 to 6 cm 2-IVinfusion and equipment for blood pressure should be in place 3-help position the woman on her side or sitting upright 4-the lumbar area of the back is cleaned antiseptic solution

13. Cont 5-local anesthetic is injected into the skin to form a wheal over the L3 and L4 vertebrae 6- a special 3to 5 inch needle is than passed through the L3-L4 interspace into the epidural space

14. Cont 7-polyethylen catheter is passed through the needle into the space and needle is then withdrawn 8-leaving the catheter to be taped in place

16. Technique for Administration after 1-asses the woman pulse and blood pressure 2-the effect of epidural anesthesia is short lived (40 minutes to 2 hours)

17. Advantages of an epidural; 1.The woman remains alert and able to participate 2.good relaxation is achieved 3.airway reflexes remain intact 4. blood loss is not excessive 5.gastric emptying is not delayed

18. The disadvantages of epidural; 1.The woman ability to move freely is limited related to use of an IV infusion 2.orthostatic hypotension 3.dizziness 4.weakness of the legs 5.sedation 6.bizarre behavior

19. 7.Tinnitus 8.disorientation 9.paresthesia 10.Respiratory arrest can occur if the relatively high dosage

20. Summary - epidural anesthesia during labor Relief from the pain of uterine contractions and birth - Contraindications to epidural block - positions epidural

21. -Technique for Administration before and after - list advantage -list disadvantages

22. Reference Book (maternal and child health nursing) fifth edition (Adele pillitteri) pags (551,554, 553)