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. 2012:2012:309219.
doi: 10.1155/2012/309219. Epub 2011 Nov 24.

Recent advances in epidural analgesia

Maria Bauer  1 , John E George 3rd, John Seif, Ehab Farag
Affiliations

Recent advances in epidural analgesia

Maria Bauer et al. Anesthesiol Res Pract. 2012.

Abstract

Neuraxial anesthesia is a term that denotes all forms of central blocks, involving the spinal, epidural, and caudal spaces. Epidural anesthesia is a versatile technique widely used in anesthetic practice. Its potential to decrease postoperative morbidity and mortality has been demonstrated by numerous studies. To maximize its perioperative benefits while minimizing potential adverse outcomes, the knowledge of factors affecting successful block placement is essential. This paper will provide an overview of the pertinent anatomical, pharmacological, immunological, and technical aspects of epidural anesthesia in both adult and pediatric populations and will discuss the recent advances, the related rare but potentially devastating complications, and the current recommendations for the use of anticoagulants in the setting of neuraxial block placement.

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Figures

Figure 1
Figure 1
Placing the probe transverse plane at the coccyx, the sacral cornua (represented in white arrows heading down) are viewed laterally as humps. Sacral hiatus is located between an upper hyperechoic line, representing the sacrococcygeal membrane or ligament and an inferior hyperechoic line representing the dorsum of the pelvic surface of the sacrum (bidirectional sided arrow).
Figure 2
Figure 2
(a) Placing the probe longitudinally between the sacral cornua will capture the dorsal surface of the sacrum, the dorsal aspect of the pelvic surface of the sacrum, and the sacrococcygeal ligament. Angiocatheter penetrated the sacrococcygeal ligament and lies in the epidural space. (b) Local Anesthetic spread through Caudal Angiocatheter in caudal epidural space.
Figure 3
Figure 3
Caudal epidural catheter passing through Angiocatheter in the epidural space.
Figure 4
Figure 4
Longitudinal view at the thoracic spine level, viewing the advancement of the caudal epidural catheter. Curved lines show spinous processes. Arrows show epidural catheter in between spinous processes.
Figure 5
Figure 5
Longitudinal view at the lumbar spine. Visualization of the local anesthetic spread confirmed the position.
See this image and copyright information in PMC

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