How to do epidural anesthesia

(1) Lateral decubitus position, both hands embrace the knee joint, jaw close to the chest, into a flexion shape.

(2) According to the surgical requirements, the spinal space between the 10th thoracic vertebra and the fourth lumbar spine spike was selected, and local anesthesia was performed first, and the puncture was performed with a spoon-like puncture needle. There are two puncture methods: (1) Puncture into the epidural cavity in a vertical direction with the spine, which is called the straight puncture method; (2) Oblique puncture from the side of the spine, called lateral puncture method.

(3) The level of puncture is mainly judged according to the change of resistance. 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 it has entered the epidural space. If there is no negative pressure and other phenomena, continue to insert the needle. If cerebrospinal fluid is found, it means that the epidural space has been penetrated into the subarachnoid space. Puncture failure should be abandoned.

(4) It has been proved that in the epidural space, the injection of anesthetics is divided. Common anesthetics are 2% lidocaine (also known as cerrocaine) or 2% dicaine, plus 0.1% epinephrine 0.1 to 0.2mL. In general, the single dose of lidocaine for adults should not exceed 500mg, and the single dose of dicaine should not exceed 60mg. Continuous epidural anesthesia can be administered successively according to the requirements of the operation. The whole process of anesthesia should pay close attention to the patient's response and the changes of the anesthetic plane.

(5) If continuous epidural anesthesia is needed, a ureteral catheter corresponding to the size of the scoop needle should be taken to test whether it is patency in advance, and the length and size of the catheter should be measured. After the inclined plane of the spoon needle was placed upward (or downward, according to the surgical requirements), the ureteral catheter was inserted into the epidural space from the needle cavity. While pulling out the needle, the catheter was slowly advanced to the epidural space. The catheter was left in the epidural space for 3 ~ 5cm, not too long. Do not take the catheter out of the lumen when pulling out the scoop needle. Inject a small amount of anesthetic about 2mL from the catheter. If there is no resistance, no local uplift, and no fluid overflow, the catheter is still in the outer lumen. Finally, the catheter left in the outside of the body was fixed on the back with a tape to prevent the protrusion and bending Angle, so as to ensure the patency of the catheter and intraoperative drug administration.

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