Regional- Epidural Neural Blockade Flashcards
what type of block is a caudal? (spinal/epidural)
Epidural
the safest point of entry into the epidural spae is where and why?
midline lunbar region
b/c spinal cord ends @ L1 in adlt
in adults you need ___ to __ mL of LA per segment being blocked
1-2 mL
Ex if you want to block T4 from L4-5. this is 12 segments to reach T4. 12 x 1-2mL segment = 12-24mL of agenet
where can epidurals be placed (anatomically)
Cervical
Thoracic
Lumbar
Sacral
what are 2 advantages of the curved epidural needles (touhy and husteab)
1) it will “bounce” odd the dura (less chance of PDPH)
2) guides catheter upward (cephalad)
What is a disatvantage of the Crawford (cutting) needle
Increased chance of PDPH
what type of epidural is the crawford good for
thoracic
what is special about the weiss needle
winged tiped
the use of catheters w/ epidurals have a lower incidence of what?
Inadequate analgesia
Multi orfice catheters have a higher incidence of what complication
IV cannulation
place the Following in order of onset (fast to slowest)
- Prilocaine
- Mepivacaine
- Bupivacaine
- Chloroprocaine
- Ropivacaine
- Lidocaine
- Chloroprocaine fast
- Prilocaine Fast
- Lidocaine Intermediate
- Mepivacaine Intermediate
- Bupivacaine slow
- Ropivacaine Slow
place the following in order of duration from shortest to longest (for a bonus name how long about each last)
Prilocaine
Mepivacaine
Bupivacaine
Chloroprocaine
Ropivacaine
Lidocaine
- Chloroprocaine 50-90 min
- Prilocaine 90-130 min
- Lidocaine 90-150 min
- Mepivacaine 120-160 min
- Bupivacaine 200-260 min
- Ropivacaine 300-600 min
The faster the onset the shorter the duration
onset
duration of action
epidural relies on _____, thats why it is dependent on Volume
Diffusion
advantages of spinal over epidual
Less time to perform
Rapid onset
Sensort and motor block quality better
Less pain during sx
Advantages of epidural over Spinal
Less risk of PDPH
less hypotension
Can prolong block with catheter
Cath for post op pain
Name the structures the needle passes through for an epidural block
Skin
Subcutaneous
Supraspinous ligament
Intraspinous ligament
Ligamentum flavum
epidural space
what is the avg distance from skin to epidural space in adult
4-6 cm
what is the avg distance from skin to epidural space in obese
up to 8 cm
what is the avg distance from skin to epidural space in thin person
3 cm
what is the most sensitive indicator of initial onset of sensory block
loss on temp sensation
what is the best way to assess temp sensory loss
Alcohol swab
what is the most accurate assessment of overall sensosry block
pinprick
why do you perform a test dose after satisfatory placement of the epidural catheter?
a test dose is designed to detect both SA and IV injection
name complications of Epidural
- Penetration of Blood vessel
- Epidural Hemotoma
- Dural puncture
- Back pain
- Neural trauma
- Air embolism
- Subdural cath
- IV catheter
- Infection
- Headache
- Hypotension
- Respiratory depression
- Horners sydrome
- Total spinal
S/S of epidural hemotoma
Sharp back pain
Leg pain
Leg numbness
motor weakness
Sphincter dysfuntion
Classic sign- block wears off and come back
treatment for epidural hemotoma
Stat MRI
Neuro consult
Surgical decompression in 8-12 hours
Caudal Epidural:
needle insertion is through what?
the sacrococcygeal membrane
