What are the causes of rupture of the dura during epidural block and how to deal with it

Epidural puncture is a blind exploratory puncture, so the piercer should be familiar with the anatomical level, slowly enter the needle during puncture, carefully understand the puncturing sensation at different levels of each intervertebral ligament, and test the disappearance of resistance and negative pressure phenomenon while entering the needle, so as to avoid the total subarachnoid block and spinal cord injury caused by puncture of the dura. Anesthesia paralyzes carelessness, seeks fast and enters the needle too fast, and sometimes mistakes

The dural membrane is perforated. Too long the inclined surface of the puncture needle and the hard texture of the catheter will increase the possibility of penetrating the dura, which is sometimes not easy to find in time. In patients with multiple epidural blocks, the epidural space is hard due to repeated trauma bleeding

The outer membrane gap makes it adhere and narrow, and even occludes in severe cases. It is easy to penetrate the dural membrane. Spinal deformity or lesion, huge abdominal tumor or ascites, spine is not easy to bend, puncture difficulty, repeated puncture, easy to penetrate the dura. Calcification of ligaments in the elderly, excessive force during puncture, can lead to dural puncture. The epidural space in children is narrower than that in adults. If children do not perform basic anesthesia or do not have enough medicine, a little movement during puncture can cause the dural penetration. Once the dural is punctured, other anesthesia methods should be used, such as puncture below the L2 space, and subarachnoid block should be used in the lower abdomen, lower extremities, or anal and perineal areas.