Physiological changes of epidural needle

Cerebrospinal fluid is colorless and transparent, pH7.40, specific gravity 1.003 ~ 1.008, local anesthetic diffusion through cerebrospinal fluid, direct action on spinal nerve roots into part of the spinal cord. Anterior root anesthesia can block motor nerve (muscle relaxation) and sympathetic nerve efferent fiber (vascular dilation, slow pulse, etc.); Sensory nerves (loss of sensation) and sympathetic afferent fibers are blocked after posterior root anesthesia. The thickness of various nerve fibers varies. The thicker the diameter, the higher the concentration of drug required and the longer the induction time. In the cephalic diffusion of local anesthetics in the CEREBROspinal fluid, the sympathetic nerve fibers with the smallest diameter are blocked first, followed by the sensory nerve, and the largest motor nerve fibers are blocked last.

After sympathetic nerve block, the resistance vessels and volume vessels in the insufflation area were dilated, the vascular bed volume was rapidly expanded, and the effective circulation blood volume was relatively insufficient. According to the level of anesthesia, blood pressure decreases to different degrees, the extent of the decrease depends on the scope of anesthesia, which can be compensated by vasoconstriction in the unanesthetized area. High level anesthesia is more likely to cause hypotension. In addition to the sacral segment of the majority of parasympathetic nerve fibers were not blocked, it has slow pulse, intestinal contraction and peristalsis hyperactivity, pulling viscera and nausea and vomiting. When the sensory nerve fibers were blocked, the same area of pain disappeared. When motor fibers are blocked, the skeletal muscles they innervate relax. The septal muscle is innervated by the cervical 3 ~ 4 nerve, and the intercostal muscle is innervated by the thoracic 1 ~ 2 spinal nerve. When the septal and intercostal muscles are completely paralyzed, spontaneous respiration disappears, and when only the intercostal muscles are completely paralyzed, respiratory depression is presented.

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