The Epidural Insertion |

Check out our labour epidural playlist for a safe approach to epidural insertion as a trainee anaesthetist/anesthesiologist
for your preparation:
1 Equipment opened carefully on sterile field
2 Eye protection + mask on (not demonstrated here)
3 Surgical scrub and sterile gown & gloves
Patient positioning:
• Relaxed shoulders, chin to chest
• Thighs parallel to bed, knees bent to 90 degrees with feet on a stable surface
• Hug pillow to help curve spine
• Maximise curvature of lumbar spine
Careful with chlorhexidine!
• Ensure the 0.5% chlorhexidine is dry prior to draping and starting the procedure
• Higher concentrations of chlorhexidine are associated with increased neurotoxicity
• Avoid chlorhexidine prep on your sterile field as much as possible. Have an assistant prep the back or do this yourself prior to surgical scrub
• If using chlorhexidine liquid, ensure it is tinted and do not place it on your epidural set up in one of the pots. This can result in catastrophic neurotoxicity if it is used instead of normal saline in the loss of resistance syringe.
• We strongly advise you apply the prep and allow it to dry as a separate procedure to the epidural itself to avoid any inadvertent errors.
Epidural observations from test dose = refer to local guidelines.
As an example:
• Continuous CTG, observe for LAST (local anaesthetic systemic toxicity) throughout
• 5 minutely foetal heart rate, maternal heart rate, SpO2 & BP for first 30 minutes then 30 minutely until birth
• Sedation score, respiratory rate,
• Sensory and motor block assessment at 30 minutes then hourly until birth’
NOTE:
• BP should remain stable after test test.
• Ensure BP is kept within 10% of baseline as placental blood flow is not autoregulated
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[@jxij99]

thank you for the video. why you check the sensory height of epidural block with ice? why not just use pin prick method? isnt ice (loss of cold sensation) determine autonomic block rather than sensory block? thank you

[@drnickmb]

Nice demo

[@ABCsofAnaesthesia]

Thanks!

[@bobpatel121]

What is the point of an epidural?

[@bellefeu4933]

spinal anesthesia. Provides analgesia to all nerves below block - great for birth, for instance, blocking all pelvic pain.

[@jongshin2189]

@@bellefeu4933 Epidural and spinal (intrathecal) anaesthesia are different. They are both a form of neuraxial anaesthesia, but the location of LA deposition is anatomically different, as suggested by the name.