The Epidural anesthesia reference article from the English Wikipedia on 24-Jul-2004 (provided by Fixed Reference: snapshots of Wikipedia from wikipedia.org)

Epidural anesthesia

Epidural anesthesia is a form of local, or more specifically regional, anaesthesia involving injection of drugs through a fine catheter placed into the epidural space. The epidural space is very close to the spinal cord, lying just outside the dura mater.

Most commonly, anesthesiologists place the catheter in the lumbar region of the spine, although sometimes a catheter is placed in the thoracic or cervical spines.

Patients getting modern epidurals generally receive a combination of local anesthetics and opioids. Common local anesthetics include lidnocaine, bupivicaine and ropivicaine. Common opioids are fentanyl and pethidine. These are then injected in relatively small doses.

In epidural anesthesia, to allow surgical procedures, larger dose are given in order to remove all feeling in a large region of the body, resulting in short term paralysis.

For epidural analgesia, as in childbirth, small doses of local anaesthetic (a lower concentraion in the same volume of fluid) are given in order to preserve some sensation and most muscle power.

The decision to have an epidural is labour is a complex one for many women and it is important that they receive accurate information in order that they may make an appropriate decision. Epidural analgesia in labour is frequently opposed by proponents of natural birth and there is all much misinformation about epidural analgesia in labour. Assertions that births with an modern epidural often involve the use of forceps, for example, have no evidence to support them.

Less common, in labour, is spinal anesthesia in which a much smaller needle (26G or 27G) is advanced slightly further to penetrate the dura and allow a rapid achievement of analgesia or anaesthesia depending on the dose given.

Table of contents

1 Side effects 2 Complications 3 Contraindications 4 Technique

Side effects

• confinement to bed
• loss of ability to move around actively during labour
• loss of sense of needs to urinate requiring placement of a urinary catheter
• mild tenderness in the area of placement is not uncommon for a few days after an epidural

Complications

these include:

• DP headache
• block failure (about 1 in 20)
• hypotension which may briefly affect baby
• significant damage to a single nerve (rare, less 1:10 000)
• paraplegia (exremely rare, less than 1:100 000)
• death (exremely rare, less than 1:100 000)

Contraindications

• bleeding disorder
• infection overlying area spine

Technique

Using a strict aseptic technique a small volume of local anaesthetic, such as 1% lignocaine, is injected into the skin and interspinous ligament. A 16 or 18 gauge Tuohy needle is then inserted into the interspinous ligament and a ‘loss of resistance’ technique is used to identify the epidural space.

Traditionally anaesthetists have used either air or saline for identifying the epidural space, depending on personal preference. However, evidence is accumulating that saline may result in more rapid and satisfactory quality of analgesia[1].

After placement of the tip of the Tuohy needle into the epidural space the catheter is threaded through the needle. Generally the catheter is then withdrawn slightly so that 4-6cm remains in the epidural space.

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