Epidural anesthesia needle puncture skills?

Epidural anesthesia is divided into single epidural anesthesia and continuous epidural anesthesia, both children and adults can be used. It is suitable for rectal surgery and anal surgery with long operation time, such as anoplasty.

Operation method: The patient is placed in the lateral position, the lower back is arched backward, and the two knees are moved closer to the abdominal wall. At the midpoint of the upper and lower spinous processes of the selected intervertebral space, make a skin mound, then insert the needle vertically, inject a small amount of medicine while inserting the needle, until the ligamentum flavum (resistance increases) exit the needle, choose a slightly thicker needle, The mound is pierced into the ligamentum flavum and withdrawn, and the spoon-head epidural puncture needle is pierced along the needle eye. When it reaches the ligamentum flavum, the resistance increases significantly. At this time, the needle core is withdrawn, and a small glass tube is connected with a small amount of isotonic saline. , and then test the resistance while slowly advancing the needle in the rotating direction. When the ligamentum flavum was penetrated, the resistance suddenly disappeared, and a little saline was inhaled, indicating that the needle tip had entered the epidural space. Remove the glass tube, connect the syringe, and suck back no cerebrospinal fluid and blood, confirming that it is indeed in the epidural space and has not entered the blood vessel and subarachnoid space by mistake. If you choose a single epidural anesthesia, you can inject medicine. When continuous epidural anesthesia is selected, the plastic catheter is inserted into the needle, the length is 3 cm beyond the needle tip, the puncture needle is withdrawn, and the plastic catheter is indwelled for fixation. After the operation, the catheter was pulled out. Commonly used anesthetics are: 2% lidocaine, 0.5% bupivacaine equal amount, add a small amount of epinephrine.

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