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Encyclopedia > Epidural
An epidural catheter after insertion. The site has been prepared with Tincture of iodine

The term epidural is often short for epidural anesthesia, a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of pain signals through nerves in or near the spinal cord. Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1530 × 2040 pixel, file size: 343 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Metadata Size of this preview: 450 × 600 pixelsFull resolution (1530 × 2040 pixel, file size: 343 KB, MIME type: image/jpeg) File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Tincture of iodine is usually 5% elemental iodine in ethanol, although it is also available in 2%, 3%, and 7% mixtures. ... Regional anaesthesia includes epidural anaesthesia, spinal anaesthesia and blocks to specific nerves to block sensation in the parts of the body served. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... The epidural space is a part of the human spine which is very close to the spinal cord, lying just outside the dura mater. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...


The epidural space (sometimes called the extradural space or peridural space) is a part of the human spine inside the spinal canal separated from the spinal cord and its surrounding cerebrospinal fluid by the dura mater. Trinomial name Homo sapiens sapiens Linnaeus, 1758 Humans, or human beings, are bipedal primates belonging to the mammalian species Homo sapiens (Latin: wise man or knowing man) in the family Hominidae (the great apes). ... A diagram of a thoracic vertebra. ... The Spinal cord nested in the vertebral column. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ...

Contents

Epidural anesthesia

Indications

Injecting medication into the epidural space is primarily performed for analgesia. This may be performed using a number of different techniques and for a variety of reasons. Additionally, some of the side-effects of epidural analgesia may be beneficial in some circumstances (e.g. vasodilation may be beneficial if the patient has peripheral vascular disease). When a catheter is placed into the epidural space (see below), the effects of the analgesia may be prolonged for several days, if required. Epidurals may be used: For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Peripheral vascular disease (PVD) is a disease in the large blood vessels of the arms, legs, and feet. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ...

  • For analgesia alone, where surgery is not contemplated. An epidural for pain relief (e.g. in childbirth) is unlikely to cause loss of muscle power, but is not usually sufficient for surgery.
  • As an adjunct to general anaesthesia. The anaesthetist may use epidural analgesia in addition to general anaesthesia. This may reduce the patient's requirement for opioid analgesics. This is suitable for a wide variety of surgery, for example gynaecological surgery (e.g. hysterectomy), orthopaedic surgery (e.g. hip replacement), general surgery (e.g. laparotomy) and vascular surgery (e.g. open aortic aneurysm repair). See also caudal epidural, below.
  • As a sole technique for surgical anaesthesia. Some operations, most frequently Caesarean section, may be performed using an epidural anaesthetic as the sole technique. Typically the patient would remain awake during the operation. The dose required for anaesthesia is much higher than that required for analgesia.
  • For post-operative analgesia, in either of the two situations above. Analgesics are given into the epidural space for a few days after surgery, provided a catheter has been inserted. Through the use of a patient-controlled analgesia (PCA) infusion pump, a patient may be given the ability to control post-surgical pain medications administered through the epidural.
  • For the treatment of back pain. Injection of analgesics and steroids into the epidural space may improve some forms of back pain. See below.
  • For the treatment of chronic pain or palliation of symptoms in terminal care, usually in the short or medium term.

A patient getting a modern epidural for pain relief generally receives a combination of local anesthetics and opioids. Common local anesthetics include lidocaine, bupivicaine, ropivicaine, and chloroprocaine. Common opioids are morphine (or hydromorphone), fentanyl, sufentanil, and pethidine (known as meperidine in the U.S.). These are then injected in relatively small doses. Occasionally other agents may be used, such as clonidine or ketamine. Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy with the emergence of a newborn infant/s from the mothers uterus. ... In modern medical practice, general anaesthesia (AmE: anesthesia) is a state of total unconsciousness resulting from general anaesthetic drugs. ... This article needs additional references or sources to facilitate its verification. ... This article or section is in need of attention from an expert on the subject. ... This article or section does not cite its references or sources. ... A laparotomy is a surgical maneuver involving an incision through the abdominal wall to gain access into the abdominal cavity. ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Patient-controlled analgesia (PCA) is any method of allowing a person in pain to adminster their own pain relief. ... Steroid skeleton of lanosterol. ... This article needs additional references or sources to facilitate its verification. ... A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... Bupivacaine (rINN) (IPA: ) is a local anaesthetic drug belonging to the amino amide group. ... Ropivacaine (1-propyl-2’,6’-pipecoloxylidide; Naropin®) is a long-acting local anesthetic given by injection to reduce the sensation of pain. ... Chloroprocaine hydrochloride (Nesacaine®, Nesacaine-MPF®) is a local anesthetic given by injection during surgical procedures and labor and delivery. ... Morphine (INN) (IPA: ) is a highly potent opiate analgesic drug and is the principal active agent in opium and the prototypical opiate. ... Hydromorphone is a drug developed in Germany in the 1920s and introduced to the mass market beginning in 1926. ... Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with an analgesic potency of about 80 times that of morphine. ... Sufentanil is a synthetic opioid analgesic drug approximately 5 to 10 times more potent than fentanyl. ... Pethidine (INN) or meperidine (USAN) (also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil®; Alodan®; Centralgin®; Demerol®; Dispadol®; Dolantin®; Dolargan® (in Poland);[1] Dolestine®; Dolosal®; Dolsin®; Mefedina®) is a fast-acting opioid analgesic drug. ... Pethidine (INN) or meperidine (USAN) (also referred to as: isonipecaine; lidol; operidine; pethanol; piridosal; Algil®; Alodan®; Centralgin®; Demerol®; Dispadol®; Dolantin®; Dolestine®; Dolosal®; Dolsin®; Mefedina®) is a fast-acting opioid analgesic drug. ... Clonidine is a centrally acting antihypertensive (to lower high blood pressure) agent, used mainly for this purpose in the past. ... Ketamine is a dissociative anesthetic for veterinary use. ...


Because of the nature of epidurals, they are most suitable for analgesia for the abdomen, pelvis or legs. They are much less suitable for analgesia for the chest, neck, or arms and are not possible for the head.


Technique

Epidural anaesthesia is performed by a trained anaesthetist with the patient either in the preferred sitting position or lying on the side. The patient is asked to arch his back, i.e. to push the small of his back out as if to assume the "posture of an angry cat". The anaesthetist palpates the patient's back and identifies suitable anatomical gaps between the bony spinous processes prior to the actual procedure. The level of the spine at which the catheter is best placed depends mainly on the site and type of an intended operation or the anatomical origin of pain, e.g. the pain during labor and childbirth.


Using a strict aseptic technique a small volume of local anaesthetic, such as 1% lidocaine, is injected into the skin and interspinous ligament. A 16, 17, or 18 gauge Tuohy needle is then inserted into the interspinous ligament and a "loss of resistance to injection" technique is used to identify the epidural space. This technique works because the interspinous ligament is extremely dense, and injection into it is almost impossible. The anaesthetist advances the Tuohy needle slowly, attempting to inject through it every millimetre or so. Typically a "pop" is felt as the ligamentum flavum is breached. The epidural space contains only loose tissue and veins, which means that injection into it is very easy. The sensation of the "pop" followed by ease of injection is a strong indicator that the tip of the needle is in the epidural space. Aseptic technique refers to a procedure that is performed under sterile conditions. ... Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ... In zootomy and dermatology, skin is the largest organ of the integumentary system made up of multiple layers of epithelial tissues that guard underlying muscles and organs. ... A Tuohy needle is a hollow needle, very slightly curved at the end, suitable for inserting epidural catheters. ... The ligamenta flava connect the laminæ of adjacent vertebræ, from the axis to the first segment of the sacrum. ...


Traditionally anaesthetists have used either air or saline for identifying the epidural space, depending on personal preference. However, evidence is accumulating that saline may result in more rapid and satisfactory quality of analgesia[1]. In medicine, saline is a solution of sodium chloride (a substance also commonly known as table salt) in sterile water, used frequently for intravenous infusion, rinsing contact lenses, and nasal irrigation (or the yogic practice called jala neti). ...


After placement of the tip of the Tuohy needle into the epidural space the catheter is threaded through the needle. The needle is then removed. Generally the catheter is then withdrawn slightly so that 4-6 cm remains in the epidural space. The catheter is a fine plastic tube, down which anaesthetics may be given into the epidural space.


Most commonly, the anaesthetist conducting an epidural places the catheter in the mid-lumbar, or lower back region of the spine, although occasionally a catheter is placed in the thoracic (chest) or cervical (neck) region. In adults, the spinal cord terminates at the first lumbar vertebra, below which lies a bundle of nerves known as the cauda equina ("horse's tail"). Hence lumbar epidurals carry a very low risk of injuring the spinal cord. Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis). ... The vertebral column seen from the side Different regions (curvatures) of the vertebral column The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ... The cauda equina is a structure within the lower end of the spinal column, that consists of nerve roots and rootlets from above. ...


A common solution for epidural infusion in childbirth or for post-operative analgesia is 0.2 percent ropivicaine and 2 μg/mL of fentanyl. This solution is infused at a rate between 4 and 14 mL/hour, following a loading dose to initiate the nerve block. Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy with the emergence of a newborn infant/s from the mothers uterus. ... Ropivacaine (1-propyl-2’,6’-pipecoloxylidide; Naropin®) is a long-acting local anesthetic given by injection to reduce the sensation of pain. ... Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with an analgesic potency of about 80 times that of morphine. ... Regional nerve blockade, or more commonly nerve block, is a general term used to refer to the injection of local anesthetic onto or near nerves. ...


Typically, the effects of the epidural are noted below a specific level on the body (dermatome). This level (the "block height") is chosen by the anaesthetist. The level is usually 3-4 dermatomes higher than the point of insertion. A very high insertion level may result in sparing of very low dermatomes. For example, a thoracic epidural may be performed for upper abdominal surgery, but may not have any effect on the perineum. However, giving very large volumes into the epidural space may spread the block both higher and lower. Dermatome has three meanings: in surgery, a surgical instrument used for slicing skin in order to perform skin grafts. ... It has been suggested that Anogenital distance be merged into this article or section. ...


In some unusual instances, it may not be required to insert a catheter into the epidural space, e.g. for steroid injections; see below. The anesthesiologist may inject medication into the epidural space through the needle, then remove the needle.


Combined spinal-epidurals

For some procedures, the anaesthetist may choose to combine the rapid onset and reliable, dense block of a spinal anaesthetic with the post-operative analgesic effects of an epidural. This is called combined spinal and epidural anaesthesia (CSE). Spinal anaesthesia is a form of local, or more specifically regional, anaesthesia involving injection of a local anaesthetic into the cerebrospinal fluid (CSF), generally through a long fine needle. ... Combined spinal and epidural anaesthesia or analgesia is a regional anaesthetic technique. ...


The anaesthetist may insert the spinal anaesthetic at one level, and the epidural at an adjacent level. Alternatively, after locating the epidural space with the Tuohy needle, a spinal needle may be inserted through the Tuohy needle into the subarachnoid space. The spinal dose is then given, the spinal needle withdrawn, and the epidural catheter inserted as normal. This method, known as the "needle-through-needle" technique, may be associated with a slightly higher risk of placing the catheter into the subarachnoid space.


Caudal epidurals

The epidural space may be entered through the sacrococcygeal membrane, using a standard 21G needle. Injecting a volume of local anaesthetic here provides good analgesia of the perineum and genital areas. This is typically a single-injection technique and a catheter is not normally placed. This is known as a caudal epidural or "caudal". The sacrococcygeal membrane is a tough fibrous membrane about 10mm long which extends from the inferior tip of the sacrum to the body of the coccyx in humans. ... It has been suggested that Anogenital distance be merged into this article or section. ...


The caudal epidural is an effective and safe analgesic technique in children undergoing pelvic or perineal surgery. It is usually combined with general anaesthesia.


Side effects

In addition to blocking the nerves which carry pain, local anaesthetic drugs in the epidural space will block other types of nerves as well, in a dose-dependent manner. Depending on the drug and dose used, the effects may last only a few minutes or up to several hours. This results in three main effects:

Pain nerves are most sensitive to the effects of the epidural. This means that a good epidural can provide analgesia without affecting muscle power or other types of sensation. The larger the dose used, the more likely it is that the side-effects will be problematic. It has been suggested that this article or section be merged with Sensation and perception psychology. ... // Proprioception (PRO-pree-o-SEP-shun (IPA pronunciation: ); from Latin proprius, meaning ones own and perception) is the sense of the relative position of neighbouring parts of the body. ... Grays FIG. 838– The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses. ... A sphygmomanometer, a device used for measuring blood pressure. ...


For example, a laboring woman may have an epidural running during labor which is providing good analgesia without impairing her ability to move around in bed. She requires a Caesarean section, and is given a large dose of epidural bupivacaine. After a few minutes, she can no longer move her legs, or feel her abdomen. Her blood pressure is noted to be lower and she is given an intravenous infusion of ephedrine or phenylephrine to compensate. During the operation, she feels no pain. Bupivacaine is a local anesthetic. ... Phenylephrine or neosynephrine is an α-adrenergic receptor agonist used primarily as a decongestant, as an agent to dilate the pupil and, rarely, to increase blood pressure. ...


Very large doses of epidural anaesthetic can cause paralysis of the intercostal muscles and diaphragm (which are responsible for breathing), and complete loss of sympathetic function, even to the heart itself, causing a profound drop in heart rate and blood pressure. This requires emergency treatment, and usually general anaesthesia. This happens because the block height is too high ("high block") and the epidural is blocking the heart's own sympathetic nerves, as well as the phrenic nerves, which supply the diaphragm. Intercostal can refer to: Intercostal muscle Highest intercostal vein Intercostal arteries This is a disambiguation page: a list of articles associated with the same title. ... Look up diaphragm in Wiktionary, the free dictionary. ... The phrenic nerve arises from the third, fourth, and fifth cervical spinal nerves (C3-C5) in humans. ...


It is considered safe practice for all patients with epidurals to be confined to bed to prevent the risk of falls.


The loss of the sensation of needing to urinate may require the placement of a urinary catheter for the duration of the epidural. Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ...


Opioid drugs in the epidural space are very safe (as well as effective). However, very large doses may cause troublesome itch, and rarely, delayed respiratory depression.


Complications of epidural use

These include:

  • Block failure (about 1 in 20). Partial failure may still give satisfactory pain relief. However, if pain relief is inadequate, another epidural may have to be performed.
  • Bloody tap (about 1 in 30-50). It is easy to injure an epidural vein with the needle. In patients who have normal blood clotting, it is extremely rare (e.g. 1 in 100,000) for problems to develop. However, in a patient who has a coagulopathy, the patient may be at risk of epidural hematoma. If blood comes back down the needle, the anesthesiologist will normally site the epidural at another level.
  • Accidental dural puncture (about 3 in 100 insertions[2]) The epidural space in the adult lumbar spine is only 3-5mm deep, which means it is comparatively easy to cross it and accidentally puncture the dura (and arachnoid) with the needle. This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause the post dural puncture headache (PDPH). This can be severe and last several days, and in some cases weeks or months. It is caused by a reduction in CSF pressure and is characterised by postural exacerbation when the patient raises their head above the lying position. If severe it may be successfully treated with a "blood patch" (a small amount of the patient's own blood given into the epidural space via another epidural needle). Most cases resolve spontaneously with time.
  • Catheter misplaced into a vein (uncommon, less than 1 in 300). Occasionally the catheter may be misplaced into an epidural vein, which results in all the anaesthetic being injected intravenously, where it can be toxic in large doses. This also results in block failure.
  • High block, as described above (uncommon, less than 1 in 500).
  • Catheter misplaced into the subarachnoid space (rare, less than 1 in 1000). If the catheter is accidentally misplaced into the subarachnoid space (e.g. after an unrecognised accidental dural puncture), normally cerebrospinal fluid can be freely aspirated from the catheter (which would usually prompt the anaesthetist to withdraw the catheter and resite it elsewhere). If, however, this is not recognised, large doses of anaesthetic may be delivered directly into the cerebrospinal fluid. This may result in a high block, or, more rarely, a total spinal, where anaesthetic is delivered directly to the brainstem, causing unconsciousness and sometimes seizures.
  • Significant damage to a single nerve (very rare, less than 1:10,000).
  • Epidural abscess formation (very rare, about 1 in 50,000-75,000). The risk increases greatly with catheters which are left in place longer than 72 hours.
  • Paraplegia (extremely rare, less than 1:100,000).
  • Arachnoiditis (extremely rare, fewer than 1000 cases in the past 50 years) [3]
  • Death (extremely rare, less than 1:100,000).

This page is a candidate to be moved to Wiktionary. ... Nontraumatic epidural hematoma in a young woman. ... A patient undergoes a lumbar puncture at the hands of a neurologist. ... This article is about the medical condition. ... Nerves (yellow) Nerves redirects here. ... Paraplegia is a condition in which the lower part of a persons body is paralyzed and cannot willfully function. ...

Contraindications

These are circumstances in which epidurals should not be used:

  • Patient refusal
  • Bleeding disorder (coagulopathy) or anticoagulant medication (e.g. warfarin)
  • Infection near the point of insertion
  • Infection in the bloodstream which may "seed" onto the catheter
  • Hypovolemia (low circulating blood volume)

This page is a candidate to be moved to Wiktionary. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ...

Cautions

There are circumstances where the risks of an epidural are higher than normal. These circumstances include:

... An uncollapsed syrinx (before surgery). ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... For other uses, see Tattoo (disambiguation). ...

Epidural analgesia in childbirth

Epidural analgesia is a relatively safe and effective method of relieving pain in labor. It provides immediate pain relief in most cases. Epidural analgesia is associated with longer labor. Some claim that it is correlated with an increased chance of operational intervention. The clinical research data on this topic is conflicting. For example, a study in Australia (Roberts, Tracy, Peat, 2000) concluded that having an epidural reduced the woman's chances of having a vaginal birth, without further interventions (such as episiotomy, forceps, ventouse or caesarean section) from 71.4% to 37.8%. Conversely, a 2001 study by researchers at the National Institute of Child Health and Human Development and a 2002 study by researchers at Cornell University and the University of Ontario demonstrated that epidurals do not increase the likelihood of a caesarean section. In 2005, a meta-analysis of 21 studies also showed that epidurals do not increase the likelihood of caesarean section, but they do increase the chance of a forceps or ventouse delivery by 40% (Anim-Somuah, Cochrane Review, 2005). The COMET Study, published in The Lancet in 2001 (vol358, No9275 p19-23) showed that a combined spinal epidural in labor may speed up the labor process by a few minutes, although those women receiving an epidural had a caesarean rate of 28% and only 35% had a normal birth without instrument assisted delivery. Medio-lateral episiotomy as baby crowns. ... Forceps are a hand-held instrument used for grasping and holding objects, similar in concept to tongs, tweezers or pincers. ... Ventouse is a vacuum device used to assist the delivery of a baby when labour has not progressed adequately. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... The National Institutes of Health is an institution of the United States government which focuses on medical research. ... Cornell University is a private university located in Ithaca, New York, USA. Its two medical campuses are in New York City and Education City, Qatar. ... The University of Ontario Institute of Technology is a unique and vibrant place, rooted in its community and powered by its people. ...


What explains these differing outcomes? There are some data that demonstrate that the likelihood of increased intervention is directly related to the quality of the institution or practitioner providing the care: epidurals administered at top-rated institutions do not generally result in a clinically significant increase in caesarean rates, whereas the risk of caesarean delivery at poorly ranked facilities seems to increase with the use of epidural[5] An alternative explanation is that women having difficult labors are more likely to request epidurals, and are also less likely to have an unassisted vaginal birth.


Some mothers worry that epidural analgesia may harm their newborn. Research puts this fear to rest: although epidural labor analgesia is associated with slower progress of labor, it has no adverse effect on perinatal outcome and perinatal complications.[6]


There is evidence to suggest that women whose epidurals contain the drug fentanyl are less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks.[7] Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with an analgesic potency of about 80 times that of morphine. ...


Epidural steroid injection

An epidural injection, or epidural steroid injection, is used to help reduce pain caused by a herniated disc, degenerative disc disease, or spinal stenosis. These spinal disorders often affect the cervical (neck) and lumbar (low back) levels of the spine. Pain may be accompanied by numbness or tingling that radiates into the arms or legs. An epidural steroid injection (ESI) may be part of a patient’s multidisciplinary treatment plan that includes physical therapy. The effects of an epidural steroid injection may be temporary or long-term. The injection works by reducing the inflammation and/or swelling of nerves in the epidural space. Categories: Medicine stubs | Orthopedics ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... This article or section does not adequately cite its references or sources. ...


Epidural steroid injections are administered in a sterile setting such as an outpatient facility or hospital. The medicine used in the injection is a combination of a local anesthetic (such as bupivacaine) and a steroid (such as triamcinolone). The procedure involves numbing the skin by injection of a local anesthetic, allowing time for the anesthetic to work, and then inserting a needle into the epidural space. The procedure is performed using fluoroscopy (a live x-ray) which enables the physician to view the placement of the needle. When the needle is properly positioned, the mixture is injected into the epidural space. Bupivacaine is a local anesthetic. ... Triamcinolone (trade names Kenalog®, Aristocort®, Nasacort®, Tri-Nasal®, Triderm®, Azmacort®, Fougera®) is a synthetic corticosteroid given orally, by injection, inhalation, or as a topical cream. ... A modern fluoroscope. ...


After the procedure, the patient is returned to the recovery area and monitored for a period of time before being released home. Patients may be asked to keep a pain diary to help them discuss their pain progress during a follow-up appointment. Some patients who have some residual pain after the first injection may receive a second or third epidural steroid injection. Patients who do not receive any relief from the first injection usually do not receive a second injection.


It is important that patients scheduled for an epidural steroid injection follow the pre-procedure instructions provided. Instructions include stopping certain medications such as blood thinning agents (e.g. aspirin, warfarin, clopidogrel) which can increase the risk of bleeding and hence epidural hematoma formation. An epidural steroid injection, like other medical procedures is not risk-free. There is a possibility of side effects and complications from the needle puncture and medications used. Aspirin, or acetylsalicylic acid (IPA: ), (acetosal) is a drug in the family of salicylates, often used as an analgesic (to relieve minor aches and pains), antipyretic (to reduce fever), and as an anti-inflammatory. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... Clopidogrel (IPA: ) is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Nontraumatic epidural hematoma in a young woman. ... A medical procedure is a course of action intended to achieve a result in the care of patients, used by medical or paramedical personnel. ...


References

  1. ^ Norman D. Epidural analgesia using loss of resistance with air versus saline: does it make a difference? Should we reevaluate our practice? AANA J 2003;71:449-53. PMID 15098532
  2. ^ Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after inadvertent dural puncture. Anesthesiology 1989;70:729-31.
  3. ^ Rice I, Wee MY, Thomson K., Obstetric epidurals and chronic adhesive arachnoiditis, Br J Anaesth. 2004 Jan;92(1):109-20. PMID 14665562
  4. ^ Tattoo dilemma, a March 2006 Hamilton Spectator article
  5. ^ Thorp JA, Breedlove G. Epidural analgesia in labor: an evaluation of risks and benefits. Birth. 1996 Jun;23(2):63-83. PMID 8826170.
  6. ^ Sieńko J, Czajkowski K, Swiatek-Zdzienicka M, Krawczyńska-Wichrzycka R., Epidural analgesia and the course of delivery in term primiparas, Ginekol Pol. 2005 Oct;76(10):806-11. PMID 16417096
  7. ^ Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA., Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006 Dec 11;1:24. PMID 17134489

The Hamilton Spectator, founded in 1846 as The Hamilton Spectator and Journal of Commerce, is a newspaper published each day but Sunday in Hamilton, Ontario, Canada. ...

Other reading

  • Roberts C, Tracy S, Peat B,Rates for obstetric intervention among private and public patients in Australia: population based descriptive study, British Medical Journal (BMJ), v321:p137, 15 July 2000
  • Jun Zhang, Michael K. Yancey, Mark A. Klebanoff, Jenifer Schwarz and Dina Schweitzer, Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment, American Journal of Obstetrics and Gynecology, Volume 185, Issue 1, July 2001, Pages 128-134.[1]
  • Barbara L. Leighton and Stephen H. Halpern, The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review, American Journal of Obstetrics and Gynecology, Volume 186, Issue 5, Part 2, May 2002, Pages S69-S77. Also available online.
  • Boqing Chen and Patrick M. Foye, UMDNJ: New Jersey Medical School, Epidural Steroid Injections: Non-surgical Treatment of Spine Pain, eMedicine: Physical Medicine and Rehabilitation (PM&R), August 2005. Also available online.

External links

  • Epidurals for pain relief in labour Comprehensive information with women's stories - informedhealthonline.org
  • Wendy Bellissimo: Willow's birth - The designer's story of her epidural during the birth of her third child
  • Epidural and nerve root injections pain treatment explained

  Results from FactBites:
 
Epidural Injection - neurologychannel (479 words)
Epidural injection is the administration of medication into the epidural space.
Epidural injections may be painful and produce uncertain results.
Epidural injection is the injection of medication into the epidural space.
Epidural - Wikipedia, the free encyclopedia (2881 words)
The epidural space (sometimes called the extradural space or peridural space) is a part of the human spine inside the spinal canal separated from the spinal cord and its surrounding cerebrospinal fluid by the dura mater.
Most commonly, the anaesthetist conducting an epidural places the catheter in the mid-lumbar, or lower back region of the spine, although occasionally a catheter is placed in the thoracic (chest) or cervical (neck) region.
A common solution for epidural infusion in childbirth or for post-operative analgesia is 0.2 percent ropivicaine and 2 μg/mL of fentanyl.
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