Epidural puncture success rate

For MANY YEARS, ANESTHESIOLOGISTS IN SOME HOSPITALS HAVE BEEN TROUBLED by the failure rate of epidural puncture when they perform epidural blocks. In general, an epidural should be successful unless there is severe ossification of the ligamentum flavum. There are no more than two methods for epidural puncture: one is to hold the needle and puncture the ligamentum flavum with a "breakthrough" feeling, and connect the saline syringe, which can be easily injected into the epidural space; The other is to hold the needle and puncture the ligamentum flavum by hand, then connect the saline syringe and apply pressure. When the injection is blocked, keep applying pressure and push the needle forward at the same time, and the saline is suddenly injected easily, indicating that it enters the epidural space. Obviously, the former has a certain failure rate, the reason is: the needle tip does not touch the ligamentum flavum in soft tissue can also be easily injected saline, punctured ligamentum flavum may not have obvious "sense of breakthrough"; The sacral spine aponucleus and intertransverse ligament are thin, and there is a "sense of breakthrough" after puncturing, which often gives the puncture illusion. The second approach has a pressurize syringes - salt water can't be injected under continuous pressure will be needle - brine was suddenly relaxed and injection process, as long as the needle into the yellow ligament, pressurize syringes are unable to maintain the pressure inside the syringe, yellow ligament is thicker, the needle into the yellow ligament brine after an injection, break through the yellow ligament into the epidural space after salt water can be easily injection. The epidural puncture success rate is 100 percent. Although the sacral spinous aponeurosis and intertransverse ligament had a "sense of breakthrough" after being punctured, they were weak and the needle incline could not be completely embedded in them. Therefore, it was impossible to maintain the pressure by pressurizing the saline in the syringe.

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