Peridural anesthesia is the term used to describe spinal anesthesia. It is one of the regional anesthesia procedures.
What is epidural anesthesia?
Peridural anesthesia is the term used to describe a spinal anesthetic. To induce spinal anesthesia, the attending physician injects a local anesthetic into the peridural space, which is part of the spinal canal. Peridural anesthesia (PDA) is also known as epidural anesthesia (EDA). This refers to regional anesthesia close to the spinal cord. In this procedure, the spiral nerves are used to block the transmission of signals such as pain. The spiral nerves originate in the spinal cord and are located in the intervertebral holes. To induce spinal anesthesia, the attending physician injects a locally acting anesthetic into the peridural space, which is part of the spinal canal. In contrast to a general anesthetic, a peridural anesthetic merely eliminates pain locally. In principle, the peridural space can be punctured at numerous sites. However, the middle area of the lumbar region is considered the safest part of the body. There, the risk of spinal cord injury is lowest.
Function, effect, and goals
Peridural anesthesia is used for a variety of medical purposes. For example, it is considered a proven local anesthetic procedure for childbirth and provides effective pain relief. It is also used to eliminate pain during a Caesarean section. Peridural anesthesia can also be used for surgical procedures in the pelvic region and on the legs and feet. Other areas of application include the alleviation of pain after accidents, postoperative pain treatment and the treatment of chronic pain or tumor pain. One of the advantages of peridural anesthesia is its long-term applicability. Thus, painkillers can be repeatedly introduced into the peridural space via a catheter. The peridural space is also called the epidural space and is part of the spinal canal. Within the peridural space lie the spiral nerves, which are blocked by an injected anesthetic. In this way, the transmission of pain can be stopped. After the injection, the local anesthetic spreads throughout the peridural space and penetrates to the intervertebral holes. Because the anesthetic must pass through the connective tissue layer of the spinal cord skin to be effective, it takes about 20 to 30 minutes to achieve full anesthesia. In contrast to spiral anesthesia, peridural anesthesia can also be used to selectively anesthetize individual areas in the abdomen or chest region. However, a combination of both anesthetic methods is also possible. In the case of extensive abdominal surgery, a combination with general anesthesia is usually used to make the procedure gentler. Before the peridural anesthesia is administered, the patient’s blood clotting must be ruled out. For this reason, the patient must not take any medications that interfere with blood clotting before the procedure. These include coumarins such as Marcumar, clopidogrel and acetylsalicylic acid. In addition, the patient should stop eating solid food six hours before the peridural anesthesia. Drinks must also be avoided for two hours before the procedure. Peridural anesthesia begins with disinfection and anesthesia of the injection site. To apply the anesthesia, the anesthesiologist uses a needle to make a puncture between the vertebrae that extends into the peridural space. Usually, the puncture takes place between lumbar vertebrae 3 and 4. However, a puncture between lumbar vertebrae 2 and 3 is also possible. A thin peridural catheter is inserted via the needle. During the procedure, additional painkillers can be administered via the catheter. After the catheter has reached its destination, the doctor removes the needle again. To prevent the plastic catheter from slipping, it is fixed in place with a bandage. To confirm the correct position, a test dose of painkillers is administered. The anesthesia is initially noticeable by a feeling of warmth before numbness sets in. The anesthetics used in peridural anesthesia include ropivacaine and bupivacaine. As part of postoperative pain management, the patient receives a low dose local anesthetic. This procedure does not affect the muscles.In this way, the patient can continue to move without feeling pain.
Risks, side effects, and dangers
Peridural anesthesia is considered a relatively safe procedure. For example, complications rarely occur if it is used correctly. The risk also depends on the type and amount of anesthetic used. For example, these preparations can have different effects on the heart and circulation. A possible undesirable side effect is a drop in blood pressure during epidural anesthesia. However, the anesthesiologist prepares for this situation accordingly and counteracts it with medication. Furthermore, shortness of breath and a slowing of the pulse are possible. Complications can also arise from the puncture. These include bruising due to vein injury, injury to the dura mater (outermost meninges) resulting in loss of neural fluid, headache, back pain, or infection. In addition, the catheter may break off, but this is usually inconsequential. Very rarely, nerve damage is seen as a result of peridural anesthesia. Thus, the spinal cord skin is not penetrated by the needle and catheter. Only in isolated cases has permanent nerve damage occurred. Another conceivable side effect is an allergic reaction to the anesthetic used. However, they also occur only very rarely. There are also some contraindications to peridural anesthesia. These include infections at the injection site, neurological diseases, blood coagulation disorders, narrowing of the spinal canal or shock. Relative contraindications include local diseases of the spine such as joint inflammation, osteoporosis (bone loss), a herniated disc, deformities of the spine, volume deficiency, and blood poisoning (sepsis). Furthermore, patient consent is also essential for this form of anesthesia.
