Experience with a high epidural puncture

Epidural anesthesia of the upper abdomen and chest can be obtained by using a small dose of local anesthetics in the thoracic segment. It can also be used for postoperative analgesia without lower limb block. Epidural puncture in the thoracic segment is the same as that in the lumbar segment, but the spinous process of the thoracic spine is more tilted downward, and the top of the previous spinous process covers the next lamina, so the direction of needle insertion is more tilted to the cephalic side. In addition, because the nerve roots of the thoracic segment are smaller than those of the lumbar and sacral segments, the block usually expands more rapidly to the cephalic side than to the caudal side. Therefore, I personally think that the strategy of giving a small amount of local anesthetic with low concentration can be adopted when performing high epidural anesthesia. In addition, if the dura is punctured, there is a risk of spinal cord injury. Therefore, the repeated suction test during the puncture is especially important! But now most of the slightly higher level of the hospital, the upper abdominal surgery and chest surgery with general anesthesia is more common, rarely use epidural anesthesia, after all, or the first ah!