Epidural Management

Question 1

In the ________ region the epidural space is ____ mm wide at midline.

Answer 1

lumbar, 5-6

Question 2

Where is the largest space found in the epidural space?

Answer 2

Lumbar region

Question 3

In the _________ region the epidural space is ____ mm wide.

Answer 3

mid-thoracic, 3-5

Question 4

Where does the local anesthetic work when placed in the epidural space?

Answer 4

Spinal nerve roots located in the lateral space.

Question 5

Local anesthetic gains access to the CSF by uptake through the ____.

Answer 5

dura

Question 6

T/F:Epidural block is slower and intensity is less compared to a spinal block.

Answer 6

TRUE

Question 7

What positions can a patient be place in for an epidural block??

Answer 7

Lateral or sitting

Question 8

What is the difference between analgesia and anesthesia?

Answer 8

Analgesia is for pain control only and anesthesia inhibits pain with no feeling.

Question 9

Provider does NOT have greater control of sensory and motor blockade compared with SAB.

Answer 9

False.

Question 10

Epidural anesthesia is ________ dependent.

Answer 10

diffusion

Question 11

What is the typical volume needed to induce an epidural anesthesia?

Answer 11

20 mL

Question 12

Why does the epidural medication take longer to achieve anesthesia?

Answer 12

Medication must get to the subarachnoid space by the process of diffusion.

Question 13

T/F: The needle should always enter the epidural space in the midline irregarless of approach used for access.

Answer 13

TRUE

Question 14

Why is it important to place the needle midline irregardless of approach?

Answer 14

At this point the epidural space is the widest and and the risk of puncturing epidural veins, spinal arteries, or spinal nerve roots is decreased.

Question 15

What tissue must you go through to provide an epidural block?

Answer 15

• Skin
• Subcutaneous fat
• Supraspinous ligament
• Interspinous ligament
• Ligamentum Flavum
• Epidural space
• Dura mater
• Arachnoid mater
• Subarachgnoid space
• Pia mater
• Spinal Cord

Question 16

T/F: The epidural space has negative pressure.

Answer 16

TRUE

Question 17

What are the two techniques called to locate the epidural space?

Answer 17

Loss of resistance technique

Hanging drop technique

Question 18

What procedures would you do if doing a thoracic epidural?

Answer 18

Upper abdominal

Thoracic regions

Question 19

What is a test dose used for?

Answer 19

Verify correct needle location

Question 20

What does the test dose usually consist of?

Answer 20

Epinephrine 1:200,000 = 0.005 mg/mL

Lidocaine 15% = 45mg/3cc

Question 21

What would be S/S if epidural needle was misplaced?

Answer 21

Increase in heart rate by 20 - 30 %.

If local placed in the CSF then local will behave like a spinal block.

Question 22

What controls the level of an epidural block?

Answer 22

Volume

Question 23

What factor affect the level of epidural block?

Answer 23

Volume 
Age
Pregnancy
Speed of injection
position
Spread of epidural block

Question 24

What is the volume needed to block one segment of vertebrae

Answer 24

1-2 cc

Question 25

Repeating dose would be how much.

Answer 25

1/2 to 1/3 the original dose

Question 26

What would be the volume needed for geriatric patient for epidural segment block?

Answer 26

0.5 to 1 cc

Question 27

What are the side effect and complication of an epidural?

Answer 27

Back ache
Post dural puncture headache
Trauma with catheter removal

Question 28

Name the different variation of an epidural?

Answer 28

Single shot
Continuous epidural anesthesia
Combined spinal (epidural anesthesia)
Combined epidural (general anesthesia)
Caudal Anesthesia