How does epidural anesthesia work?

The operation method is as follows:

(1) In the lateral position, hold the knee joint with both hands, and bend the lower jaw close to the chest.

(2) Select the vertebral space between the 10th thoracic vertebrae and the 4th lumbar spine spikes according to the surgical requirements, perform local anesthesia first, and puncture with a spoon-shaped needle head. There are two puncture methods: (1) Directly puncture the epidural space in a vertical direction with the spine; ② Oblique puncture from the side of the spine is called lateral puncture.

(3) The puncture is mainly based on the change of resistance to judge the layers passed. Resistance increases, when faced with yellow ligament have strong feeling, then take out the needle core, connected with a small amount of air (or saline) cylinder, continue to carefully into the needle, you have sense of "escapes" worn out yellow ligament, the use of epidural negative pressure air suction chamber in the cylinder, and observe the cylinder head of fluid level change, if as the change of negative pressure and fluctuations, It means the epidural space has been entered. If there is no negative pressure and other phenomena, continue to enter the needle. If cerebrospinal fluid is found, it means that the extra-dural space has been penetrated and entered the subarachnoid space. The puncture will fail and should be abandoned.

(4) If the epidural space is proved, anesthesia is injected in stages. Commonly used anesthetics are 2% lidocaine (also known as serocaine) or 2% decaine, 0.1% epinephrine added 0.1 ~ 0.2mL. Generally, a single dose of lidocaine for adults should not exceed 500mg, and a single dose of dicaine should not exceed 60mg. Continuous epidural anesthesia can be administered in batches according to surgical requirements. During the whole process of anesthesia, the patient's reaction and the change of anesthesia level should be carefully observed.

(5) If continuous epidural anesthesia is required, a ureter catheter corresponding to the size of a spoon-shaped needle should be taken first to test whether it is unobpatency in advance, and the length and size should be measured. After inserting the ureteral catheter into the epidural space from the needle cavity, pull out the needle and slowly advance the catheter to the epidural space, leaving the catheter in the epidural space 3 ~ 5cm, not too long. Do not take the catheter out of the lumen when removing the spoon-shaped needle. Inject a small amount of anesthetic about 2mL into the catheter. If there is no resistance, no local uplift, and no liquid overflow, it proves that the catheter is still in the lumen. Finally, the catheter left outside the body was fixed flat and straight on the back with adhesive tape to prevent prolapse and bending into Angle, so as to ensure the catheter patency and intraoperative medication.

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