Puncture technique of epidural anesthesia needle

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

2, strict disinfection.

3. There are two kinds of puncture positions: lateral decubitus and sitting, and lateral decubitus is mainly used clinically. The puncture point should be selected according to the surgical site, and the corresponding space of spinous process dominating the center of the surgical range is generally taken. Usually, the puncture point of upper limb is in thoracic spinous process space of 3-4, upper abdominal surgery is in thoracic spinous process space of 8-10, middle abdominal surgery is in thoracic spinous process space of 9-11, lower abdominal surgery is in thoracic 12 to lumbar 2 spinous process space, lower limb surgery is in lumbar 3-4 spinous process space, perineal surgery is in lumbar 4-5 space, and sacral tube anesthesia can also be used. The spinous space is determined by referring to the anatomical markers of the body surface. If the neck is obviously prominent spinous process, for the neck spinous process; On both sides, the scapular link intersects with the 3 thoracic spinous process; The subscapular Angle on both sides intersects the 7 spinous process of the thorax; The highest point of iliac crest on both sides intersects with the 4 spinous process of the lumbar spine or the 3~4 spinous process space of the lumbar spine.

4. There are two kinds of epidural space puncture: direct approach and side approach. The spinous process of the cervical vertebra, the upper thoracic vertebra and the lumbar vertebra are parallel to each other. The spinous process of the middle and lower segments of the thoracic vertebrae is imbricated and the space is narrow. The elderly with calcification of the supraspinous ligament and limited curvature of the spine should generally use the side-approach method.

5. Suspension drop method can be used in negative pressure experiment, and injection air is not recommended to determine whether it enters the epidural space.