Epidural anaesthesia

Question 1

Indications for Epidural

Answer 1

sole anaesthetic for lower abdominal procedures
pain relief
with GA for hypotensive anaesthesia eg eye surgery
post op pain relief
obstetrics

Question 2

advantages of epidural

Answer 2

excellent pain relief
can top up
patient can mobilise
reduced risk of chest infection, DVt
reduced bleeding

Question 3

disadvantages of epidural

Answer 3

higher risk of infection as leaving catheter in
risk of post dural headache
can be difficult to perform

Question 4

Anatomy of epidural space

Answer 4

between ligamentum flavum and dura

filled with fat and blood vessels

Question 5

Tuohy needle

Answer 5

16-18G, 8cm long
1cm interval surface marking
blunt bevel with 15-30 degree curve tip

Question 6

differences between spinal and epidural

Answer 6

epidural less dense block, can top up, larger needle used, into epidural space, longer onset, greater dose, loss of resistance syringe

Question 7

Complications of epidural

Answer 7

Hypotension
inadvertent high epidural block
LA toxicity
total spina
accidental spinal puncture
epidural haematoma, infection
failure of block

Question 8

What is epidural anaesthesia

Answer 8

central nerve block technique.  LA injected into epidural space surrounding dura.  Temporary blockage of sensory and autonomic nerves.  NOT motor
More difficult to perform than spinals
Larger doses of LA at higher concentration required
slow onset (20-30 mins to take effect)