Epidural needle puncture method

1. Blind probing method Epidural puncture can be performed by direct approach and lateral approach. The spinous processes of cervical vertebra, upper thoracic vertebra and lumbar vertebra are parallel to each other. The spinous process of the middle and lower thoracic vertebrae is imbricated, and the gap is narrow. When puncture is difficult, lateral approach can be used. Elderly spinous ligament calcification, spinal curve restricted, generally appropriate to use side into the law.

Through direct approach, the selected spinous process space near the upper edge of the lower spinous process was used to make the skin mounds, and then layer by layer infiltration. 15 G sharp acupuncture could be used to break the skin and ligament, and then the epidural needle was inserted along the pinhole. The position of the needle must be in the midsagittal line of the spine. The needle tip passed through the subcutaneous supraspinous ligament interspinous ligament ligamentum flavum and other tissue levels, and the resistance suddenly disappeared when penetrating the flavum ligamentum, indicating that it entered the epidural space (Figure 4).

In the lateral approach, a needle was inserted at 1.5 cm next to the spinous process space, and the needle was inserted at a 75° Angle with the skin towards the interspinous process foramen, avoiding the supraspinal ligament and the interspinous sband, and entering the epidural space through the ligamentum flavum (FIG.5).

Catheterization method for continuous epidural block: After the epidural needle was confirmed to enter the epidural cavity, the inclined plane of the needle was directed toward the cephalic or caudal side, and a marked 20 G catheter was inserted through the epidural needle cavity. The catheter should exceed the needle tip and enter the epidural space 3 ~ 4 cm. Secure the catheter with a sterile dressing. Catheter placement allows multiple or continuous drug injections.

Drug and dosage: Inject local anesthetic of test amount first, generally use 3 ~ 5 ml of 1.6% ~ 2% lidocaine. Prior to injection, suction must be returned to confirm no blood and cerebrospinal fluid.

2. Ultrasound localization guided puncture has been widely used in minimally invasive surgical anesthesia, regional block, vascular puncture and other aspects, which also provides a new method for epidural puncture catheter placement. High-quality ultrasound imaging can help the operator quickly and accurately locate the epidural space, and guide the needle and catheter into the epidural space to complete the epidural fixed position tube, which can reduce the number of fitting, reduce the discomfort of patients, and improve patient satisfaction.

The operation procedure is to scan the highest point of iliac crest and mark it, then move the probe to the cephalic end, scan the lumbar interstitial space and spinous process, and locate the measured intersection at the third spinous process. The epidural associated structure was identified and the clearest space was shown, which was opened about 1.0cm from the midline as the puncture point. The puncture site was routinely disinfected. After local anesthesia with 1% lidocaine, the puncture site was used as the center of the probe for paramedian longitudinal scanning.

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