How to deal with it? What are the reasons for the dura mater punctured during epidural block?

Epidural puncture is a kind of blind puncture, so the punctureer should be familiar with the anatomical level, slowly insert the needle during puncture, carefully experience the puncture sensation of each intervertebral ligament at different levels, and test the disappearance of resistance and negative pressure while inserting the needle. , to avoid perforating the dura mater leading to total subarachnoid block and spinal cord injury. The anesthetist is paralyzed and careless, and the needle is pushed too hard when he wants to be fast.

cause dural perforation. If the puncture needle is too long and the catheter is too hard, it will increase the possibility of perforating the dura mater, which is sometimes difficult to detect in time. Patients who have undergone epidural block for many times, the epidural space is hard due to repeated trauma and bleeding, and drug and chemical stimulation

The extramembranous space makes it adhere and narrow, and even atresia in severe cases, and it is easy to penetrate the dura mater. Spinal deformity or disease, huge intra-abdominal tumor or ascites, the spine is not easy to bend, the puncture is difficult, repeated puncture, easy to penetrate the dura. In the elderly, ligament calcification and excessive force during puncture can cause dural perforation. The epidural space in children is narrower than that in adults. If the child does not have basic anesthesia or the dose is insufficient, a little movement during puncture can cause the dura to perforate. Once the dura is broken, other anesthesia methods should be used, such as puncture below the L2 space, the surgical area in the lower abdomen, lower extremities or anus, perineal area, and subarachnoid space block.

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