Puncture technique for epidural anesthesia

1. In order to prevent and treat general spinal anesthesia, it is necessary to prepare endotracheal intubation device, oxygen supply equipment and other first aid supplies.

2, strict disinfection.

3. There are two kinds of puncture positions: lateral decubitus and sitting position, and lateral decubitus is mainly used in clinical practice. The puncture point should be selected according to the surgical site, generally taking the corresponding spinous process space innervating the center of the surgical range. Usually, the puncture point of the upper limb is in the thoracic 3~4 spinous process space, the upper abdominal surgery is in the thoracic 8~10 spinous process space, the middle abdominal surgery is in the thoracic 9~11 spinous process space, the lower abdominal surgery is in the thoracic 12 to the lumbar 2 spinous process space, the lower limb surgery is in the lumbar 3~4 spinous process space, the perineal surgery is in the lumbar 4~5 space, and the sacral anesthesia can also be used. To determine the spinous process space, the general reference is body surface anatomical markers. Such as neck prominent spinous process, for the lower cervical spinous process; Both sides of the scapular ganglia meet the 3 thoracic spinous process; Both sides of the subscapular Angle are connected to the thoracic 7 spinous process; The highest point of the iliac crest on both sides is connected to the lumbar 4 spinous process or the lumbar 3~4 spinous process space.

4. There are two kinds of epidural space puncture: direct puncture and para-puncture. The spinous processes of cervical vertebrae, thoracic vertebrae and lumbar vertebrae are parallel to each other. The spinous process of the middle and lower segments of the thoracic vertebrae is imbricate, and the gap is narrow. The paracentesis method can be used when the puncture is difficult. In the elderly with calcification of the supraspinous ligament and limited curvature of the spine, it is generally appropriate to use the side approach.

5. The negative pressure test can be performed by hanging drop method. It is not recommended to use injected air to determine whether to enter the epidural space.

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