EPIDURAL anesthesia 11 objectives position procedure

Epidural Anesthesia

Objectives

•   To provide anesthesia for procedures and surgical inter­ventions (i.e., urological, gynecological, obstetrics, abdominal and orthopedic surgeries) by giving local anesthesia into the epidural space.

•   This technique is also used for providing postoperative analgesia.

•   Written consent for procedure is required.

Position

Same as for spinal anesthesia.

Premedication

•   Oral premedication given.

Procedure

   1.  Procedure explained to the patient.

   2.  On a tiltable table.

   3.  Performed at any level of spinal cord according to the desired level of analgesia.

   4.  Thoracic, lumbar or caudal epidural practiced.

   5.  The duration of action can be prolonged by intermittent injections through an epidural catheter.

   6.  Epidural needles are thick and curved tips (16, 18, 20 G Tuophy).

   7.  Intravenous line started.

   8.  Patient attached to ECG, SpO2 and NIBP, monitor.

   9.  Scrub and wear sterile gown and gloves.

10.  Check the epidural set on the sterile trolley for the items required, proper size needle and catheter; proper fitting of syringe into the hub of epidural needle.

11.  Fill in a 20 ml syringe the local anesthesia to be injected into the epidural space.

12.  Read the label of drug vial carefully for the name, percentage, baricity, expiry date. Confirm it with assistant.

13.  Local anesthetic to be used for skin infiltration taken into a 2 ml syringe (2 cc, 2% xylocaine).

14.  Cover the drug tray with a sterile towel to avoid spilling of antiseptic solution during cleaning.

15.  Clean the back with antiseptic swab same as spinal procedure.

16.  At L4 space, skin is infiltrated with local anesthetic with a 24/25 G needle - A skin puncture is made with a 18 G needle.

17.  Epidural needle is introduced in the above point upto supraspinous ligament.

18.  Stylet is withdrawn and attach a 10 ml syringe with 5 to
6 ml of air.

19.  Needle advanced further using firm but gentle pressure on the plunger of the syringe till there is a sudden loss of resistance to pressure on the plunger.

20.  The epidural space correct position is further checked by adding a drop of local anesthetic deposited at the hub which will be sucked in if in correct place.

21.  The drug slowly injected attaching the 20 ml syringe into the epidural space, directly after a test dose of 2 ml or

22.  Epidural catheter is inserted through the needle (if intermittent dosage is required).

23.  The catheter is introduced upto 3rd mark.

24.  Needle is carefully withdrawn.

25.  Catheter is adjusted upto 2nd mark .

26.  It is strapped to the back of the patient.

27.  Drug is given through the catheter slowly.

28.  Onset of action after 15-20 minutes.

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