How are Epidurals Performed? [video]

Video author: Streaming Well
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Video Transcript
What is an epidural?

Daman Mulhi: Epidurals are used in many different areas of anesthesia. Typically one associates them with labor, but actually they're used within the realms of having an operation, they're used for pain management—for example, chronic pain, patients with back pain. An epidural is a technique whereby local anesthetic is introduced into the epidural space. This is a small space surrounding the spinal column. It can be given as a single shot, or as an infusion. This is done via a small, plastic catheter that remains in the back and is attached to a local anesthetic infusion.

How is an epidural administered?

This is a very brief overview of the epidural kit and how the anesthetist will perform an epidural. The whole procedure is done under sterile conditions, so before the anesthetist starts, the back will be cleaned, and sterile drapes will be applied to the body. Following this, the anesthetist will freeze the skin where he or she is going to insert the epidural by injecting some local anesthetic. The local anesthetic needle is much smaller than this needle, so the time when this needle is inserted should not be painful.

As the epidural needle is inserted, at the same time, a syringe is inserted onto the end. The needle is used to find the space. It's inserted between the bones in the lower part of the back. The needle is advanced very slowly. At the same time, pressure is applied gently to the syringe. Just before one reaches the epidural space, the needle will come up against a ligament called the ligamentum flavum, and this is quite gritty, and you get an increased amount of resistance. At this point, the epidural space is very close, so the needle is just advanced a very small amount further. There's a very sudden and convincing loss of resistance, and at this point, one knows that one is in the epidural space. The syringe is removed, and now the epidural catheter is inserted. This is just a very fine, plastic tube. It is threaded through the needle, and this is all that remains in the body.

Patients get worried that is they're having an epidural, they think that the needle might stay in, but no. The needle is removed, and all that remains in the body is this very fine, plastic tube. You're able to lie back and function normally. This end of the catheter is then attached to what we call a filter. We then attach the infusion of local anesthetic to this end of the filter, and the idea is that you gradually get local anesthetic infused into the body through the catheter, and the body that is distal to this part of the catheter then gradually gets numbed. In essence, that's how we perform an epidural, either for your operation or for pain relief afterwards.

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