Epidural Anaesthesia

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Epidural Anaesthesia :

Epidural space has Negative pressure.

Drugs:
Lignocaine : 1-2%
Bupivacaine : 0.25 - 0.5%

Drug required is high - 15 - 20ml (Penetrates intervertebral foramina into CSF)
So there are high chances of Total Spinal anaesthesia and LA toxicity.
Also epidural space has large number of veins - Venous plexus of Batson

Needle : Tuohy Needle , Crowford Needle

How to know if we are in the Epidural space ?
1. Loss of resistence (On piercing Ligamentum flavum)
2. Hanging drop technique. ( Gutierrez's sign )
3. Rapid injection in the space causes increase in rate and depth of respiration. ( Duran's Sign )
4. Absence of knee jerk after epidural block. (Westphal sign )


Advantages over Spinal Anaesthesia:

• Less Hypotension
• No headache
• Level block can be done
• Any duration can be performed.

Disadvantages :

• Patchy block (therefore give fentanyl)
• Chances of Unsuccessful block
• High chance of total spinal
• Expensive
• Effect starts in 15-20mins [ therefore use combine Spinal and Epidural (CSE) ]

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Caudal Block = Sacral epidural block :  LSCS  NOT Possible with this.

Drug injected - Xylocaine 2mg/kg , in Sacral hiatus.

Most commonly used in children

Good for Perineal surgeries and infra-umblical pain relief in children.

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