Epidural needle method

The puncture point should be selected according to the surgical site, and the corresponding gap between the central spinous process is generally taken to dominate the surgical range.

There are two methods of puncture: direct puncture and lateral puncture. The patient is prepared with lumbar anesthesia. After selecting the puncture space, the direct approach was carried out at the midpoint of the puncture space, through the skin, the supraspinal ligament and the interspinous ligament to reach the ligamentum flavum. In the lateral approach, the needle is inserted about 1 cm from the midline of the spinous process, and the needle body is perpendicular to the back skin and straight forward to the lamina. The needle is slightly withdrawn so that the needle body and the midline are inclined to an Angle of about 30 degrees. For lumbar puncture, the tip should be explored forward to reach the ligamentum flavum, while for thoracic puncture, the tip should be gradually tilted towards the head along the back of the lamina to find the spinous process space. When the tip of the needle touched the ligamentum flavum, there was a sense of firmness, and the resistance increased. After the ligamentum flavum was broken through, there was a sense of failure, indicating that the tip of the needle had reached the epidural space.

The method to judge the needle entering the epidural space is as follows: ① The resistance disappears suddenly when the needle passes through the ligamentum flavum, and no cerebrospinal fluid is pumped back. (2) Negative pressure test: with a thin glass tube of water column, connected to the puncture needle, through the ligamentum flavum into the epidural cavity, the liquid in the glass tube was sucked into the epidural cavity under negative pressure. Suspension drop method can also be used. ③ Resistance test: use a 5 ml syringe filled with a small amount of normal saline or local anesthetic, and keep a small bubble, connected to the needle. Gently push the syringe core, if there is resistance, the bubble compression becomes smaller, indicating that the tip is not in the epidural cavity; if there is no resistance, the bubble is not compressed, indicating that it is in the epidural cavity. Similarly, if the needle tip is not in the epidural cavity, there will be obvious resistance when the syringe is filled with several milliliters of air, and there will be no resistance when the syringe is in the epidural cavity. After gas injection, the syringe is removed immediately, sometimes bubbles can be seen to gush from the end of the puncture needle.

Make sure the needle tip is in the epidural space, and then insert the epidural catheter into the needle tube. After the needle is removed, the catheter should be indwelled in the epidural space 2 ~ 3 cm. The test dose was injected through a catheter, which was equivalent to one dose of lumbar anesthesia, and then the maintenance dose was injected 5 minutes later.

Sacral canal puncture: to reach the sacral epidural space through the sacral hiatus. The fifth sacral vertebra has no spinous process, and the left and right lamina are not closed in the midline. The hiatus between them is the sacral attack foramen, and there is a sacral Angle about the size of a bean on both sides. The depression felt by finger is about 3 cm upward along the dorsal midline from the coccyx tip. The puncture was performed in decubitus or lateral position in the center of the sacral hiatus with 20-22 needle puncture through the skin, subcutaneous and through the sacral caudate ligament. There was an obvious sense of breakthrough, indicating that the sacral canal was entered into the lumen, and no blood and cerebrospinal fluid were extracted, and then the drug could be injected.

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