Epidural Flashcards
What is Epidural
A central nerve block technique involving an injection of local anaesthetic into the epidural space and close to the nerves that transmit pain”
How does epidural work
Opiates/analgesics into the epidural space in the spinal column, numbing the discom
Regional differences in Epidural
Epidural anaesthesia : Local anaesthetic injected between the spinal column and the outer membrane of the spinal cord (into the ‘epidural space’ by bolus injection, continuous injection or patient controlled analgesia.
Spinal anaesthesia: A single dose of local anaesthetic and/ or opiate injected to the subachranoid space into the cerebral spinal fluid.
This is faster and shorter acting form of regional anaesthesia.
Combined spinal-epidural anaesthesia: Single spinal injection when the epidural catheter remains in situ.
CSA is faster acting than an epidural.
Reasons for epidural
Maternal Request / Women’s choice
Maintains BP for hypertensive women (may even cause small reduction)
Preterm labour – to avoid narcotic drugs
Prolonged labour – to reduce exhaustion
Assists planned instrumental deliveries
Multiple pregnancy
Women with cardiac, respiratory, cerebrovascular disorders
Indications for epidural
Antenatal indications: Breech presentation Twins Pregnancy induced hypertension Inatrauterine death Previous caesarean section
Intrapartum indications: Pain Maternal request Induction? Augmentation of labour Fetal blood sampling Occipito posterior position Malpresentation Instrumental delivery
Postnatal indications:
Suturing
Manual removal of placenta
Administration of epidural
Needle is inserted into lumber spine in the L3-L4 or L4-L5 intervertebral spaces.
Drugs may be inserted into the epidural or intrathecal spaces.
Injection into the fat in the narrow space between the dura and the bony canal.
Circulates in the epidural space
Diffuses through the dura where it act on nerve roots (local anaesthetics) or receptors in the spinal cord
