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Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Epidural analgesia involves the placement of local anesthetics often combined with low-dose opioids in the epidural space via a small-gauge catheter. The posterior epidural space is bound by the ligamentum flavum posteriorly and the dura anteriorly. Typically, the patient is placed in a sitting or lateral decubitus position. The lumbar approach is commonly used, most often L2 to L5. Following an aseptic technique with local anesthetic injected at the chosen interspace, an epidural needle is inserted into the epidural space utilizing a “loss of resistance” technique with a syringe filled with saline or air. An epidural catheter is then threaded into the epidural space and the needle is removed. The catheter is then secured and local anesthetic infused until an appropriate level of analgesia is achieved. Since the epidural catheter can be placed intravascularly or in the subarachnoid space, a test dose is performed to rule out placement at these sites. A small dose of local anesthetic with epinephrine is injected via the catheter following careful aspiration. Typical test doses include 45mg of lidocaine and 15mcg of epinephrine. If injected IV the small dose of epinephrine will cause a transient maternal tachycardia. If injected into the subarachnoid space, the parturient will develop a limited motor block. Neither of these responses will occur if the catheter is in the epidural space.
Analgesia
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is an epidural set (Figure 4.3). It consists of an epidural needle, a catheter and a loss of resistance syringe. It is inserted at any level along the spinal cord into the epidural space using the loss of resistance (LOR) technique to provide both anaesthesia and analgesia for surgery and analgesia in labour.
Seeking control over birth in the Middle East
Published in Hannah Dahlen, Bashi Kumar-Hazard, Virginia Schmied, Birthing Outside the System, 2020
Suha Hussein, Virginia Schmied
After another hour, the pain became unbearable. I began to feel that I had come to a place that I could not escape. I knew there was nowhere to run from the pain. I would have done anything for the pain to go away. After 24 hours of lying there, induced and in pain, I asked the midwife for an epidural, but she said the anaesthetist was busy with an operation. She suggested that I have some pethidine instead. I refused and started screaming and demanding an epidural. Finally, I was given an epidural. I was in so much pain, I struggled while the anaesthetist was trying to insert the epidural needle, but I liked the feeling when it was working.
Bilateral continuous erector spinae block versus multimodal intravenous analgesia in coronary bypass surgery. A Randomized Trial
Published in Egyptian Journal of Anaesthesia, 2021
Sanaa F. Wasfy, Ghada A. Kamhawy, Ahmed H. Omar, Heba F. Abd El Aziz
Before induction of anesthesia in group B, we counted and marked spinous processes from C7 to T7 while the patient was in the sitting position. We were guided by bony landmarks and ultrasound scanning. Bilateral ESPB was performed after induction of general anesthesia and positioning the patient in lateral position. Left lateral position was preferred as the radial arterial catheter was often inserted in the left forearm. We used a linear transducer 6–12 MHz (SonoSite M-turbo, USA). The probe was firstly placed in a transverse view over the T5 spinous process and then we moved laterally to view the lamina followed by the transverse process at approximately 3 cm from the median plane. Lastly, we rotated the probe to obtain a longitudinal view of adjacent transverse processes at the paramedian sagittal plane. Three muscles from superficial to deep were seen (trapezius, rhomboids and ES) above the hyperechoic transverse processes. In plane toughy, epidural needle was inserted deep to ES muscle from caudal to cephalic direction. Correct needle location was visualized by saline hydrodissection and then epidural catheter (B Braun Epidural kit) was threaded and secured. The same steps were repeated on the other side (Figure 1).
Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis
Published in Upsala Journal of Medical Sciences, 2018
Ola Winsö, Josef Kral, Wanzhong Wang, Ivana Kralova, Pernilla Abrahamsson, Göran Johansson, Per-Jonas Blind
The epidural space was accessed under radiographic guidance in the midline between the spinous processes of the eighth and ninth vertebrae, using a 20-gauge epidural needle (Braun, Melsungen, Germany) and the loss-of-resistance technique. The correct catheter position was verified by contrast-medium injection (Ultravist 300®; Schering AG, Berlin, Germany) via a standard epidural catheter in all animals (Figure 1). With the aim of blocking segments T5 to T12, the animals received 0.75 mL per segment of 0.5% bupivacaine (Marcaine, Astra Zeneca, Sweden) as a bolus dose, followed by 0.15 mL/kg/h as a continuous epidural infusion.
Effect of encouraging a combined spinal epidural technique for cesarean delivery anesthesia
Published in Baylor University Medical Center Proceedings, 2022
Alexa Borja, Jessica Ehrig, Kristen Vanderhoef, Kendall Hammonds, Michael P. Hofkamp
One limitation of our study is that we were not able to perform an economic analysis of the difference in price between single-shot spinal and combined spinal anesthesia trays since our hospital’s acquisition costs of this equipment is propriety in nature. Another limitation of our study was that we eliminated four subjects with unintentional puncture of the dura with an epidural needle because the management of this anesthetic complication is markedly different from routine management of a combined spinal epidural anesthetic.