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Parenteral Drug Administration: Routes of Administration and Devices
Published in Sandeep Nema, John D. Ludwig, Parenteral Medications, 2019
Himanshu Bhattacharjee, Vivian Loveless, Laura A. Thoma
The epidural space (or extradural space or peridural space) is a part of the human spine. It is the space inside the bony spinal canal but outside the membrane called the dura mater (Figure 2.5). In contact with the inner surface of the dura is another membrane called the arachnoid matter. The arachnoid space encompasses the cerebrospinal fluid that surrounds the spinal cord. The term “epidural” is often synonymous with epidural anesthesia, and it is a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation and analgesia, by blocking the transmission of signals through nerves in or near the spinal cord.
Spine
Published in David A Lisle, Imaging for Students, 2012
Injection of LACS into the epidural space (Fig. 9.15) may be performed for various indications including:Back pain and/or sciatica due to spinal stenosis‘Discogenic’ back pain due to degenerative changes in intervertebral discs.
Current devices used for the monitoring of injection pressure during peripheral nerve blocks
Published in Expert Review of Medical Devices, 2018
Finally, another potential application for injection pressure monitoring is the objective determination of a change in resistance during needle advancement. During location of the epidural space, clinicians typically use a ‘loss of resistance’ technique whereby a syringe filled with air or saline is attached to a needle and advanced through the tough interspinous ligament toward the epidural space. Since the ligamentous tissue prevents injection, flow cannot occur with moderate pressure. Upon passage through the ligamentum flavum into the epidural space, the resistance decreases and flow can occur. This technique relies on a keenly developed ‘feel’ and appreciation for the interaction of ‘just the right amount of pressure’ on the syringe with respect to the various ligamentous structures. Failure to appreciate this sensation can result either in inadvertent dural puncture or inappropriate identification of the epidural space and failure of the block. While force-sensing technologies have been validated for identification of the epidural space in ex vivo animal models, these are not currently commercially available [33,34]. The use of an in-line objective pressure monitor or limiter such as the BSmart™ or NerveGuard™ may be useful in providing a quantifiable and clear endpoint in these cases. This is also an area that is underexplored but is worth investigating.