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is withdrawn and attach a 10 ml syringe with 5 to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.
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is carefully withdrawn.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.
Any questions be sent to drmmkapur@gmail.com
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