EPIDURAL ANAESTHESIA

The epidural space is a low pressure space between the ligamentum flavum and the duramatter occupied by areolar tissue, loose fat and internal

vertebral venous plexus.
Located at the level of L3 –L4

Apparatus required:
16/18G toony needle
23/27G needle
Sensocaine
Procedure
• inject the 2% lignocaine jelly at the selected point to provide local anaesthesia
• wait 30 sec for lignocaine to act
• insert the epidural needle through the supra sinous ligament
• attaching a syringe with 7mi of saline and holding the hub of the needle firmly. Push the needle inwards steadily and continuosly and the needle

enters the epidural space with the saline flowing in freely
• avoid going beyond 5cm marking in the needle as the sub arachnoid space is likely to be entered.
• Then place the catheter after checking it the filter by flushing with the saline
• Insert the catheter up to 15-20-cm
• Push the catheter in while removing the needle to prevent it being pulled out
• Then the catheter is withdrawn to 8-10cm and the filter is connected
• Test dose is administered to identify whether the catheter or needle is in IV or sub-arachnoid space
Drugs :
1. Bupivaccine 0.5% for anaesthesia and 0.1 –0.25% for analgesic
2. Fentanyl 2 to improve the quality of analgesia
3. Morphine and diamorphine to prolong the duration of analgesia
Volume
1. Depends upon the distance between the point of injection and the site of surgery
2. volume should be reduced in elderly obesity and pregnancy.