At the turn of the 20th century, they independently introduced single-shot caudal nerve blocks with cocaine for neurologic and genitourinary procedures, respectively. The French physicians Jean Sicard and Fernand Cathelin are credited with the first intentional administration of epidural anesthesia. Despite coining the term spinal anesthesia, he may unknowingly have been investigating the epidural space. Leonard Corning proposed injecting an anesthetic solution into the epidural space in the 1880s, but devoted his research primarily to subarachnoid nerve blocks. More detailed information about local anesthetics (LAs), the mechanism of neuraxial block, the combined spinal-epidural (CSE) technique, obstetric anesthesia, and complications of central neuraxial block is provided following the links.įrom the Compendium of Regional Anesthesia: Epidural anesthesia infographic.
These include controversies about epidural space anatomy, the traditional epinephrine test dose, methods used to identify the epidural space, and whether particular clinical outcomes may be improved with epidural techniques when compared to GA. This chapter also addresses several areas of controversy concerning epidural techniques. After a brief history of the transformation from single-shot to continuous epidural catheter techniques, it reviews (1) indications for and contraindications to epidural block (2) basic anatomic considerations for epidural placement (3) physiologic effects of epidural block (4) pharmacology of drugs used for epidural anesthesia and analgesia (5) techniques for successful epidural placement and (6) major and minor complications associated with epidural block. This chapter covers the essentials of epidural anesthesia and analgesia. Epidural block may also reduce the surgical stress response, the risk of cancer recurrence, the incidence of perioperative thromboembolic events, and, possibly, the morbidity and mortality associated with major surgery. In addition, epidural techniques are used increasingly for diagnostic procedures, acute pain therapy, and management of chronic pain.
Epidural analgesia is often used to supplement general anesthesia (GA) for surgical procedures in patients of all ages with moderate-to severe comorbid disease provide analgesia in the intraoperative, postoperative, peripartum, and end-of-life settings and can be used as the primary anesthetic for surgeries from the mediastinum to the lower extremities. INTRODUCTIONĬlinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. Maloney, MB, BAO, ChB, for his help with the tables and figures. *The authors would like to thank Michael A.
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