Chapter

Epidural block

Graeme McLeod

in Principles and Practice of Regional Anaesthesia

Fourth edition

Published on behalf of Oxford University Press

Published in print November 2012 | ISBN: 9780199586691
Published online November 2012 | e-ISBN: 9780191755507 | DOI: http://dx.doi.org/10.1093/med/9780199586691.003.0014

Series: Oxford Textbooks in Anaesthesia

Epidural block

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Epidural block has now become well established as an adjunct to general anaesthesia and is regarded as the most effective means of providing pain relief after surgery and during labour (Dolin et al. 2002). Regardless of the type of surgery and means of assessing pain, epidural block provides better pain relief than parenteral opioids (Block et al. 2003). Several factors have contributed to this: 1. Placement of a catheter in the epidural space is a relatively straightforward procedure; 2. Epidural block may be extended for several days into the postoperative period if needed; 3. Quality pain relief allows effective coughing and early mobilization; and 4. Acute pain teams are available to provide continuity of management. There are, however, disadvantages: 1. Visceral sensation remains intact and general anaesthesia is needed as a supplement for major surgery of the thorax and abdomen; 2. Surgery to the trunk requires thoracic epidural block, but inexperienced anaesthetists tend to insert catheters several dermatomes below the ideal, ‘mid-incisional’ level, resulting in inadequate pain relief and lower limb motor block; 3. Performance of the block adds to anaesthesia time; and 4. Pre-existing neurological conditions, coagulation disorders, and pharmacological thromboprophylaxis are weightier contraindications to epidural block than to other regional techniques because bleeding into the epidural space is not always immediately apparent, cannot be controlled directly, and may only be revealed when it causes symptoms.

Chapter.  13693 words.  Illustrated.

Subjects: Anaesthetics ; Clinical Skills ; Anatomy

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