Main items of epidural space nerve block

1. Piercing the dura mater Compared with adults, the distance between the skin of children and the epidural space is very short, and it is easy to accidentally pierce the dura mater. Once the dura mater is pierced, an appropriate dose of local anesthetic can be injected into the subarachnoid space, which becomes a spinal nerve block. If the epidural block is still needed, move up a vertebral space and re-puncture the tube to keep the tip of the epidural catheter away from the punctured dura. However, consideration should be given to the possibility of spinal nerve block after injection through this epidural catheter.

2. Total spinal cord palsy Injecting a large amount of local anesthetics into the subarachnoid space by mistake can cause total spinal cord palsy. This is the most serious complication of this technique. Once it occurs, local anesthetics can block all spinal nerves, paralyze the respiratory muscles and stop breathing. The drugs enter the skull from the foramen magnum to make the patient disappear. The vasodilation causes a sudden drop in blood pressure and even cardiac arrest. Therefore, this operation must be performed in the operating room or a treatment room with equivalent conditions, and rescue items such as booster drugs, anesthesia machines and tracheal intubation supplies should be prepared.

3. Mistake of medicines into blood vessels Mistake of local anesthetics into the epidural blood vessels can cause toxic reactions in the central nervous system and cardiovascular system, leading to convulsions and cardiac arrest.

4. Direct spinal cord injury The end of the spinal cord in children is lower than the lumbar 2 vertebral body, and the newborn is at the level of the lumbar 3 vertebral body. Epidural puncture is performed above the lumbar 3-4 gap. Because of rough movements or unskilled operations, on the basis of piercing the dura mater, further needle insertion can lead to direct spinal cord injury.

5. Others After puncturing the dura mater with an epidural needle, the chance of headache is very high. Patients with coagulopathy may develop epidural hematoma. Severe infections such as epidural space abscess can occur when the aseptic operation is not strict.

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