CRITICAL PROCEDURE

TECHNIQUE OF PROVIDING EPIDURAL ANALGESIA

Abstract

Epidural analgesia provides excellent relief of pain in areas innervated by spinal cord segments,
below the upper thoracic Level. The area easiest to reach with least risk of injuring spinal cord is lower lumbar area.
To administer an epidural analgesic, place the patient in lateral or sitting position with lumbar spine fully flexed. Raise
a wheal with local anaesthetic at L4 – 5 inter-spinous level, between dorsal spine, and advance an 18-gauge needle
through the skin, sub-cutaneous layer, supra spinous ligament, interspinous ligament, and finally ligamentum flavum.
A loss of resistance signals that the needle has entered epidural space. Dural puncture is most common clinically
significant complication. Placement of an analgesic agent in the epidural space provides superb analgesia for most
patients. Many patients in ICU, particularly those who have undergone surgery or who have sustained major trauma
are candidates for this therapy. Cancer pain and pain associated with labor and delivery have been well controlled by
it. In post operative and trauma patients, epidural analgesia is associated with improved pulmonary function and an
overall reduction in complications like pulmonary infections and cardiovascular problems. Other advantages of epidural
analgesia include early mobilization, less incidence of deep vein thrombosis and earlier post operative tracheal
extubation. I will begin with brief discussion of spinal anatomy and description of indications and contra indications of
epidural analgesia. Then technique most commonly employed to provide epidural analgesia and confirmation of
epidural placement of needle or catheter will be discussed. Finally possible complications and their management will
be reviewed.