epidural anaesthesia

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The term "epidural" usually is short for epidural
analgesia
, which is a
form of
regional analgesia that involves the injection of drugs
by means of a
catheter placed into epidural
space
. This injection can cause both loss of sensation (anaesthesia)
and loss of pain (analgesia), by blocking the process of
transmission of signals by nerves in / near the spinal cord.(1)

The epidural
space
is the space that is inside the bony spinal canal but it is
outside the membrane called as dura matter. In contact
with inner surface of the duramatter is
an another membrane called as the
arachnoid
matter
. The arachnoid membrane encompasses the
cerebrospinal fluid(csf) that surrounds the spinal
cord
.(1)

How epidural anaesthesia differs from spinal anesthesia???

Spinal anaesthesia :it is a
technique in which a local anaesthetic is injected into cerebrospinal fluid. This
technique has little similarity to epidural anaesthesia, and the 2 techniques
may be easily confused with each other. The main Differences include:(2)

The space involved
is larger for an epidural anaesthesia, and thus the injected dose is larger,
which is about 10-20 ml in epidural anaesthesia compared to 1,5-3,5 ml in that
of a spinal anaesthesia.(2)

In an epidural anaesthesia,
an catheter may be placed that avails for the additional injections later,
while a spinal is generally one-shot
only; although a continuous spinal can also be administered, especially in the
pain management.

The onset of analgesia
is nearly 15-30 min in an epidural anaesthesia, while it is approximately 5
minutes in a spinalanaesthesia.

An epidural anaesthesia
generally doesn't cause a neuromuscular block at
the lower effective analgesic dosages, while a spinal
more often does this.

An epidural anaesthesia
may be given at a thoracic / lumbar site, while a spinal must be injected below L2 to restrict piercing of the spinal cord.

With epidural
anaesthesia, it is possible to create the segmental blocks as opposed to spinal
where the block involves all segments below the highest level of the given anesthesia.

The extension of
block with epidural anesthesia is highly dependent on volume and rate of injection. The position of
the patient has no impact on the level
of the block.(3)

With spinal
anesthesia, the density of solution
combined with that of the position of
the patient influences the level of the block mainly.

Indications:(3)

Injecting
medication to the epidural space is
mainly performed for analgesia. Some of the side-effects caused
due to epidural analgesia may be advantageous in some of the circumstances .
When a catheter is placed into epidural space a continuous infusion can be maintained for
several days.Epidural analgesia may be used.

Technique of the insertion(4)

Epidural
anaesthesia generally requires a large level of technical proficiency to avoid
serious complications, and it should always be performed by a trained
anaesthetist, by using strict aseptic technique to reduce the risk of the infection.

  • Position
    of the patient during epidural anaesthesia
  • Feeding
    by the catheter
  • Anaesthetic
    drugs
  • Bolus
    or infusion?
  • Removing
    the catheter

References:

http://en.wikipedia.org/wiki/Epidural (accessed on 31st may,2011,5:2p.m)

http://en.wikipedia.org/wiki/Combined_dspinal_and_epidural_anaesthesia(accessed
on 31st may,2011,5:2p.m)

http://www.nda.ox.ac.uk/wfsa/html/u13/u1311_01.htm(accessed
on 31st may,2011,5:2p.m)

http://www.netdoctor.co.uk/health_advice/facts/epidural.htm(accessed
on 31st may,2011,5:2p.m)

"THIS BLOG DOES NOT CONTAIN ANY PLAGIARISED MATERIAL"

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Comments

G.Sailesh's picture

Can you please tell me about the conditions under which this type of anesthesia has to be carried out and the drugs that are administered through this route?
Sandhya Sravya malla's picture

It is most widely used in case of childbirth to reduce the labour pains. during the childbirth, epidural anaesthetic is generally started during the labour and given before the neck of the womb starts to dilate. It is very effective upto 96 percent of the cases.besides providing the pain relief and anaesthesia during the process of childbirth,it is also used during certain operations like itis usually recommended for: knee surgery, hip surgery reconstruct arteries in lower legs, amputation of lower limbs, operations of the genitals or bladder, surgery in varicose veins, hernias and in case of piles (haemorrhoids) the drugs used in case of epidural anaesthesia are local anaesthetics like LIDOCAINE,MEPIVACAINE,BUPIVACAINE,ROPIVACAINE and opiods like morphine,oxymorphone,hydromorphone,buprenorphine,fentanyl....... m.sandhyasravya PHARMA WARRIORS
Siva Mavuduru's picture
Sandhya Sravya malla's picture

THANK U SIVA m.sandhyasravya@gmail.com PHARMA WARRIORS

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