Spinals and epidurals Flashcards
2 different types of needles
- pencil point (less pain and trauma)
- cutting
sizes of spinal needles
- 22-27 gauge
- 90-145 mm
absolute contraindications
- patient refusal
- lack of cooperation
- uncorrected coagulopathies
- infection at the site of block
- hypovolemia
- increased ICP
factors that effect uptake and spread from subarachnoid space
- concentration of LA in CSF
- surface area of nerve exposed
- lipid content of nerve tissue
- blood flow to nerve tissue
factors effecting distribution of spinals
- baricity
- position
- dose
factors that effect the level of a spinal
- baricity
- position
- dose
- site of injection
- age
- speed of injection
- volume
- concentration
CV changes with spinal
- sympathectomy dependent on block height
- hypotension and bradycardia
- veno and arterial dilation
- treat with fluids, ephedrine, neo
- bradycardia is usually first
GI changes with spinal
- sympathetic innervation from T6- L2
- increased secretions
- sphincters relax
- bowel constricts
- N&V in about 20%
- atropine to treat after high spinal
what to do when you encounter paresthesia during catheter insertion
- stop advancing
- remove stylet and check for CSF flow
where is the catheter positioned when doing the paramedian approach
- 1 cm lateral and 1 cm inferior to space
- angle needle medially and cephalad
incidence of neurological injury
- 0.03% 1:240,000
signs of cauda equina syndrome
- loss of perianal sensory loss
- decreased rectal motor tone and lower extremity weakness
- high posts-void residual
post dural puncture headache (PDPH) S&S
- 25% incidence
- worse when head is up, relief when supine
treatment of PDPH
- fluids
- caffeine (500mg)
- bed rest
- analgesics
- sumatriptan
- blood patch
epidural levels
- usually L2-L4
- can use adult levels after age 8
vertebrae level where vasomotor level is controlled
T5- L1
what is the key factor effecting coverage area for epidural
- volume
how much volume to administer in epidural
- 1-2 ml for each level to be blocked
- lumbar spreads more cephalad than caudal
factors effecting coverage of an epidural
- age
- height
- pregnancy and obesity
reasons for decreased dose with epidural
- pregnancy and obesity from epidural vein engorgement and increase adipose tissue
- increased age = decreased dose
how many ml to give based on pt height
< 5’ 2” use 1 ml / level
> 5’ 2” use 0.1 ml for each 2 inches
caudal block
- needle inserted at 45 degree angle
- pop through sacrococcygeal membrane
- then drop needle to 160 degrees
- advance no more than 1.5 cm adults and 0.5 cm in children
- aspirate for blood and csf
test dose for epidural
- 3ml of 1.5% lido with 15 mcg of epi
how much catheter to leave in the patient
3-5 cm
never withdraw the catheter through the needle
