Epidural

Question 1

What is an epidural?

Answer 1

Method of medication administration where a medicine is injected into the epidural space, usually an opioid or analgesic.

Question 2

How is an epidural carried out?

Answer 2

• Can be administered at any point in the spine, but most commonly lumbar spine (iliac crest is a common landmark at L4; note that spinal cord terminates at L1/2).
• Threading a needle between bones and ligaments to reach epidural space, then saline/air is pumped into the space to confirm placement – there should be no resistance on insertion.
• The needle has a 90-degree curved tip so that a catheter can be inserted vertically directly into the epidural space
• Needle is withdrawn over the catheter on correct placement
• Photo: pink is dura mater, light green is epidural space

Question 3

What are the indications for an epidural? (x3)

Answer 3

• Pain relief during childbirth – using LA or opioid
• Pain relief after surgeries. Benefit over using systemic opioids, such as reduced risk of postoperative respiratory problems and intestinal motility issues with systemic analgesics. This is because lower doses can be administered due to more localised result; only sensory nerves are affected, and less-sensitive motor nerves are spared.
• Treat nerve root pain, radicular pain and inflammation caused by conditions such as spinal disc herniation, degenerative disc disease and spinal stenosis

Question 4

What are the complications of an epidural? (x4)

Answer 4

• CSF fluid leakage leading to post-dural-puncture headache
• Subdural haematoma
• Cerebral venous thrombosis
• Epidural veins may be punctured which causes problems in patients with coagulopathy