Needle Puncture Technique for Epidural Anesthesia

1. In order to prevent and treat total spinal anesthesia, a tracheal intubation device, oxygen supply equipment and other first aid supplies must be prepared.

2. Strictly disinfect.

3. There are two types of puncture positions: lateral position and sitting position. The lateral position is mainly used clinically. The puncture point should be selected according to the surgical site, generally the corresponding spinous process space in the center of the surgical scope is used. Usually the upper limb puncture point is in the thoracic 3~4 spinous process space, the upper abdomen surgery is in the chest 8~10 spinous process space, the mid-abdominal surgery is in the chest 9~11 spinous process space, and the lower abdomen surgery is in the chest 12 to waist 2 spinous process space. Lower limb surgery is performed in the lumbar 3-4 spinous process space, and perineal surgery is in the lumbar 4-5 space. Sacral canal anesthesia can also be used. To determine the spinous process space, generally refer to the anatomical landmarks of the body surface. For example, the prominent spinous process on the neck is the inferior cervical spinous process; the spine lines on both sides intersect the thorax 3 spinous processes; the two subscapular horns intersect the thorax 7 spinous processes; the highest points of the iliac crests on both sides intersect. In the lumbar 4 spinous process or the lumbar 3~4 spinous process gap.

4. There are two types of epidural space puncture: direct entry method and side entry method. The spinous processes of the cervical spine, the upper thoracic spine and the lumbar spine are parallel to each other, and the straight approach method is mostly advocated; the middle and lower spinous processes of the thoracic spine are shingled and the gap is narrow. When puncture is difficult, the side approach method can be used. For the elderly with calcification of the supraspinous ligament and restricted curvature of the spine, the bypass method is generally appropriate.

5. The negative pressure experiment can use the hanging drop method. It is not recommended to use injected air to judge whether it enters the epidural space.

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