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Key Concepts
Spinal, epidural, and caudal block are also
known as neuraxial anesthesia
The principal site of action for neuraxial
blockade is the nerve root.
Interruption of efferent autonomic
transmission at the spinal nerve roots can
produce sympathetic and some
parasympathetic blockade.
Excessive or symptomatic
bradycardia should be treated with
atropine, and hypotension should be
treated with vasopressors
Indications of Neuraxial
blockade
May used alone or in connjuction with
GA for most procedures below the neck
Cardiac surgeryThoracic epidural
Primarylower
abdominal,inguinal,urogenital,rectal,lo
wer extremity surgeries
Upper abdominal
(cholecystectomy)spinal or epidural
Contraindication to neuroaxial
blockade
Absolute
Infection at the site of injection
Patient refusal
Coagulopathy or diathesis bleeding
Severe hypovolemia
Increased intracranial pressure
Severe aortic stenosis
Severe mitral stenosis
Relative
Sepsis
Uncooperative patient
Preexisting neurological defisits
Stenotic valvular heart lesions
Severe spinal deformity
Complications Of neuraxial
anesthesia
Adverse or exaggerated physiological
responses
Urinary retention
High Block: Spinal anesthesia ascending
into the cervical levels causes severe
hypotension, bradycardia, and respiratory
insuffiency.
Total Spinal anesthesia
Cardiac arrest
Anterior spinal artery syndrome
Horners syndrome
Catheter shearing/retention
Inflammation
Arachnoiditis
Infection
Meningitis
Epidural abcess
Drug toxicity
Systemic local anesthetic toxicity
Transient neurological sysptoms
Cauda equina syndrome
Spinal Anesthesia
Spinal anesthesia blocks nerve roots as
they course through the subarachnoid
space
Spinal arachnoid space extends from
foramen magnum to the S2 in adults and
S3 in children
Factors affecting the level of spinal
anesthesia:baricity of anesthetic solution,
position,drug dosage,site injection
Epidural Anesthesia
For epidural anesthesia, a sudden loss of
resistance is encountered as the needle
penetrates the ligamentum flavum and enters the
epidural space. For spinal anesthesia, the needle
is advanced further through the epidural space
and penetrates the dura-subarachnoid
membranes as signaled by free flowing
cerebrospinal fluid.
Epidural anesthesia is a neuraxial technique
offering a range of aplications wider than the
typical all-or-nothing spinal anesthetic. An
epidural block can be performed at the lumbar,
thoracic, or cervical level
Caudal Anesthesia
Caudal epidural anesthesia is one of the
most commonly used regional techniques
in pediatric patientscommonly after
induction of general anesthesia.
It may also be used in anorectal surgery
in adults.
No longer commonly used for obstetric
analgesiauseful for second stage of
labor
Interscaleneshoulder,arm and
forearm
Axillaryelbow to hand
Infraclavicularhand,forearm,elbow,up
per arm
Bier blockshort surgical procedures
Femoral nerve blockthigh,kneeskin
graft,knee arthroscopy,patellar surgery
Contraindications Peripheral
Nerve Blocks
Uncooperative patient
Bleeding diathesis
Infection
Local anesthetic toxicity: if too much
Peripheral neuropathy: contralateral
phrenic nerve palsyipsilateral
interscalene block,contraindicated