Epidural Management Flashcards
In the ________ region the epidural space is ____ mm wide at midline.
lumbar, 5-6
Where is the largest space found in the epidural space?
Lumbar region
In the _________ region the epidural space is ____ mm wide.
mid-thoracic, 3-5
Where does the local anesthetic work when placed in the epidural space?
Spinal nerve roots located in the lateral space.
Local anesthetic gains access to the CSF by uptake through the ____.
dura
T/F:Epidural block is slower and intensity is less compared to a spinal block.
TRUE
What positions can a patient be place in for an epidural block??
Lateral or sitting
What is the difference between analgesia and anesthesia?
Analgesia is for pain control only and anesthesia inhibits pain with no feeling.
Provider does NOT have greater control of sensory and motor blockade compared with SAB.
False.
Epidural anesthesia is ________ dependent.
diffusion
What is the typical volume needed to induce an epidural anesthesia?
20 mL
Why does the epidural medication take longer to achieve anesthesia?
Medication must get to the subarachnoid space by the process of diffusion.
T/F: The needle should always enter the epidural space in the midline irregarless of approach used for access.
TRUE
Why is it important to place the needle midline irregardless of approach?
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.
What tissue must you go through to provide an epidural block?
- Skin
- Subcutaneous fat
- Supraspinous ligament
- Interspinous ligament
- Ligamentum Flavum
- Epidural space
- Dura mater
- Arachnoid mater
- Subarachgnoid space
- Pia mater
- Spinal Cord
T/F: The epidural space has negative pressure.
TRUE
What are the two techniques called to locate the epidural space?
Loss of resistance technique
Hanging drop technique
What procedures would you do if doing a thoracic epidural?
Upper abdominal
Thoracic regions
What is a test dose used for?
Verify correct needle location
What does the test dose usually consist of?
Epinephrine 1:200,000 = 0.005 mg/mL
Lidocaine 15% = 45mg/3cc
What would be S/S if epidural needle was misplaced?
Increase in heart rate by 20 - 30 %.
If local placed in the CSF then local will behave like a spinal block.
What controls the level of an epidural block?
Volume
What factor affect the level of epidural block?
Volume Age Pregnancy Speed of injection position Spread of epidural block
What is the volume needed to block one segment of vertebrae
1-2 cc
Repeating dose would be how much.
1/2 to 1/3 the original dose
What would be the volume needed for geriatric patient for epidural segment block?
0.5 to 1 cc
What are the side effect and complication of an epidural?
Back ache
Post dural puncture headache
Trauma with catheter removal
Name the different variation of an epidural?
Single shot Continuous epidural anesthesia Combined spinal (epidural anesthesia) Combined epidural (general anesthesia) Caudal Anesthesia
