Puncture technique for epidural anesthesia

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

2. Strict disinfection.

3. There are two kinds of puncture positions: lateral position and sitting position. Clinically, the lateral position is mainly used. The puncture point should be selected according to the surgical site, and the corresponding spinous process space in the center of the surgical scope is generally selected. Usually, the upper limb puncture point is in the thoracic 3~4 spinous process space, the upper abdominal operation is in the thoracic 8~10 spinous process space, the middle abdominal operation is in the thoracic 9~11 spinous process space, and the lower abdominal operation is in the thoracic 12 to waist 2 spinous process space. Lower extremity surgery is performed in the lumbar 3~4 spinous process space, and perineal surgery is performed in the lumbar 4~5 space, and sacral anesthesia can also be used. To determine the spinous process space, generally refer to the surface anatomical landmarks. For example, the prominent spinous process in the neck is the inferior cervical spinous process; the connecting line of the scapular spine on both sides meets the thoracic 3 spinous process; the connecting line of the inferior scapular angle on both sides meets the thoracic 7 spinous process; the connecting line of the highest point of the iliac crest on both sides intersects In the lumbar 4 spinous process or the lumbar 3~4 spinous process space.

4. There are two types of epidural puncture: direct entry method and side entry method. The spinous processes of the cervical, upper thoracic, and lumbar vertebrae are parallel to each other, and the straight-in approach is often advocated. In elderly people with calcified supraspinous ligaments and restricted spinal curvature, the side entry method should generally be used.

5. The negative pressure test can be carried out by the hanging drop method. It is not recommended to use air injection to determine whether it has entered the epidural space.

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