Epidural anesthesia contraindications and indications. The difference between the spinal procedure and epidural anesthesia. About the method of anesthesia

As often happens in such cases, these contradictions are associated with a lack of knowledge about Epiduril and are based mainly on delusions and speculation. We will analyze the most common myths about this method of kindness of childbirth to help future parents understand that they are valid, and what is just a fiction.

Myth number 1. Birth is a natural process, and it is not necessary to anesthetize

There are various individual features of the health of the health of feminine or flow generic activityaggravating painfulness future mom During battles. Sometimes doctors have to face the so-called pathologically low threshold of pain sensitivity of the fever. Such a term designate the high reactivity of the central nervous system in response to minimal pain stimuli. Low owner painful rock Much earlier begin to experience pain in childbirth, and the degree of discomfort they have much more intense than in women with conventional pain sensitivity. At the same time, the intensity of pain during the battles is so significant that the woman in labor can not tolerate it. In such cases, one psychological preparation for childbirth and self-adhesive skills may not be enough. In those situations where the use of physiological measures of anesthesia in childbirth (massage, respiratory techniques, aquaterapy, active behavior in childbirth) turns out to be ineffective, modern medicine Offer medical anesthesia childbirth with epidural anesthesia.

Myth number 2. Anesthesia in childbirth is needed only for anesthesia

Epidural anesthesia in childbirth is applied not only to the aims of pain relief, it can be corrected with it various pathology development of generic activities. There are a number of clay complications in which epidural anesthesia is the only effective method of treatment, which allows to normalize the generic process, to avoid the need for surgery and maintain the health of the mother and fetus. So, this type of anesthesia is used to treat the discoordination of generic activities - pathology, in which the uterus is reduced painfully and unsystematic, and the dynamics of generic activity - the disclosure of the cervix - is absent. This complication is most often associated with an increased psycho-emotional excitability of the female in the background of fear before childbirth. Because of the pathological emotional excitement, the activity of the cerebral cortex increases, and signals coordinating generic activities come to the uterus randomly and unevenly. As a result, instead of a focused reduction in the myometrium (muscle wall of the uterus), which should ensure the disclosure of the neck and promotion of the fetus, a lot of ineffective focal abbreviations occurs in the uterus wall.

In addition to such muscular activity is unproductive, that is, it does not cause disclosure, it represents the danger to the health of the fever and the fetus. As a result of permanent focal contractions of the myometrium, blood flow in uterine and placental vessels carrying oxygen to the fetus are disturbed. If for several hours, generic activity is not ordered, such contractions can lead to acute intrauterine hypoxia ( oxygen starvation) Fetal. For mom, discoordination is dangerous with the pair of placenta and even the tip of the uterus. Epidural anesthesia helps to quickly normalize nervous regulation Miometric contractions due to a pronounced painkillery effect. As soon as anesthetic begins to act, painful sensitivity disappears in the woman in labor. After having ceased to feel the fight, the woman no longer fear and calms down, which, in turn, means a decrease in the pathological activity of the cerebral cortex. In the future, the nervous impulses come to the uterus evenly, it begins to shrink productively, and the childbirth continues naturally.

Another pathology of generic activity, in which "Epiduralka" is used, is associated with dotition of the cervix. This complication is characterized by the lack of disclosure of the cervix on the background of intense increasing contractions due to the biological immaturity of the genital tract. This term denote the inconsistency of the state of the cervix and the walls of the vagina period of pregnancy. Normally, before childbirth, the cervix is \u200b\u200bgradually shortened and begins to open, the tissues of the vagina and neck become soft and elastic. If at the time of the beginning of regular generic activities, the cervix remains dense and long, as in the middle of pregnancy, and cervical Canal - Closed, disclosure does not occur, despite the active contractual activity of the uterus. Such a variant of the development of childbirth, of course, is pathology and is dangerous to health mom and fetus: Against the background of enhanced killers, cervical breaks can occur, the neck of the cervix from the body of the uterus, and the separation of the lateral walls of the uterus. These complications are extremely dangerous, they are accompanied by massive bleeding, require emergency operational intervention and can lead to the death of the guinea (from blood loss) and the fetus (from acute hypoxia). Most. effective method The correction of such an unsuccessful scenario of childbirth is epidural anesthesia. If there is strong fights "Epidurack" works, as a powerful spasmolytic that promotes the rapid softening of the cervix and its non-massive disclosure.

Epidural anesthesia is also used for artificially maintaining normal level arterial pressure in childbirth in women suffering various forms arterial hypertension. In addition, "Epiduralka" is completely indispensable in cases where it is required to minimize or even completely eliminate the wave period, without resorting to the operational delivery. We are talking about diseases in which the future mother can give birth to herself, but full participation in the process in the process can harm her health. An example of such a situation is the vices of the heart or violation heart Rhythm feminine, problems with the retina, high blood pressure eye bottom varicose disease, thrombophlebitis (inflammation of the vascular wall with the formation of blood clots, the same arterial hypertension (high blood pressure). In these cases, to facilitate the waving period, the effect of epidural anesthesia is extended almost to the head of the head of the head (the appearance of the head in the lumen of the perineum during the contraction). Then a crotch incision is made, and the baby is born with minimal physical effort from the mother, while maintaining its health and not subject to risks associated with the need for operational intervention.

Myth # 3. For epidural anesthesia use drugs dangerous for the future mother and baby

This opinion is an absolute relation: neither drugs or other potent drugs in this embodiment is just used. This is the main advantage of epidural anesthesia and makes it the most preferred embodiment of childbirth. Preparations used for "epidural", familiar to most future parents ... by visiting dental Cabinet: It is these drugs that are used for "freezing" in the treatment of teeth. These are drugs of a novocaine series: lidocaine and more modern derivatives, for example, Sovpocine and Merkocaine. These medicines do not penetrate the placental barrier and, thus, do not directly affect the fetus. In addition, when conducting epidural anesthesia, these drugs do not have time to get into the overall bloodstream: drugs are introduced into the spinal channel and dissolve in spinal fluid. However, this does not mean that anesthetics are completely safe: individual intolerance is often found to the drugs of this group, so before holding anesthesia, the doctor always thoroughly asks for the future mother about allergic reactions on the medication drugs And first introduces a test dose of medication, carefully watching her well-being.

Myth number 4. When conducting epidural anesthesia in the back is constantly the needle, which can damage the spinal cord

This is the most common fear associated with the use of "Epiduraki" in future parents. In fact, it is completely bustned: the medicine is not introduced into the spinal cord, but in the spinal channel, which contains a liquid, a liquid, washing the spinal cord, and it does not receive through the "needle in the back", but on a special catheter, which anesthesiologist establishes carrying out the manipulation of pain relief in childbirth. In order to understand everything, we will tell you more about the methodology for epidural anesthesia. Future mom is asked to occupy an initial position that facilitates the doctor holding the manipulation. There are two options for the initial position of the patient, depending on its well-being, a phase of generic activity and anatomical features The structure of the spine. In the first case, the fever put his back to the doctor and asking to tilt their heads to the knees. In the second version, the future mother takes the same "embryo pose" in the position lying on the side with his back to the doctor. After the surface anesthesia of the skin in the field of intervention, the doctor makes a puncture between the vertebrae using a special needle that does not remain in the back in the patient, but only serves as a conductor. Then, through this needle, a soft flexible tube is introduced into the place of the puncture - the finest catheter, according to which the medicine will flow into the spinal channel. After the introduction of the needle catheter is removed, and the future mother can move freely, change the position of the body, lying on the back or turning with the side on the side. The outer part of the catheter is attached to the skin sticky plaster, and a aseptic bandage is superimposed on the place of the puncture. During the childbirth, the doctor can add anesthetic dose on a catheter.

Myth number 5. If the need for caesarean sections arises, epidural anesthesia will have to interrupt and do anesthesia

Once: in modern obstetrics, epidural and spinal anesthesia are the main and most preferred method of anesthesia at various operational interventionsah, primarily with operational delivery with the help of the cesarean section.

Myth number 6. Epidural anesthesia affects the consciousness of the women in labor

And again delusion: "Epiduralka" does not affect the patient's consciousness, does not mist, it does not cause artificial drowsiness or apathy, keeps the clarity of thinking, cutting out only pain. As a result of such anesthesia in the genus "cut off" pain signals from the uterus to the brain. That is, in fact, the pain remains, but the "distress signal" sent by painful receptors during the cuts of the uterus does not reach the pain of the brain, since the introduction of anesthetic in the spinal channel is blocked by the transmission of the nerve pulse. The well-being of a future mother, is inthibhered in this way, differs significantly from the effect of ordinary painkillers. This has its advantages and its cons. The pros is the absence of negative influence On Central nervous system. Medicines used for anesthesia do not possess slying effect, in no way change the consciousness of the future mother, do not cause a vomit reflex. During the anesthesia, the fever still feels the fight, but only as muscular abbreviationBut there is no pain. The minuses include the forced position of the feminine: after the introduction of the drug, it can not get up - the sensitivity is lost below the injection site, sometimes not only painful, but any other.

Myth number 7. Anesthesia does not affect childbirth

Unfortunately, this is also invalid statement. Another problem associated with the use of "Epidurilka" is related to its influence on the rate of development of the generic process. In some cases, after applying anesthesia, the fights weaken, the opening of the cervix and the advancement of the fetus generic ways It is delayed, and in the future doctors have to be used by drug relations (enhancing kits). Sometimes, on the contrary, immediately after the start of the epidural anesthesia, generic activities are developing too rapidly, and childbirth occur within the next few hours. Such kinds are considered complicated, since too fast the birth of the baby is associated with the danger of serious breaks of the genital pathways and generic injuries of the fetus. In addition, when using anesthesia, it is difficult to accurately calculate the end time of the drug; But it is important that the sensitivity has restored at the time of the female in labor and she could control the press muscles to fully sleep.

Myth number 8. Epidural anesthesia can be done by all women in labor

In fact, it is not. There are a number of women's health features, in which the use of this type of pain relief is contraindicated. Here is an example of the most common contraindications to the use of epidural anesthesia during childbirth for the health of the future mother:

high intracranial pressure due to injuries, tumors, aneurysm (extensions of vessels) and brain hemorrhages;
pronounced osteochondrosis in the zone of the intended puncture;
availability of hernia or protrusions (protruding) spinal cord in the manipulation zone;
the curvature of the spine, which violates its normal anatomical structure and preventing the puncture of the intervertebral space;
infectious processes On the skin of the back in the zone of the intended puncture (furuncular, rash, eczema).

Due to the fact that last years significantly expanded the testimony for the use of epidural anesthesia in childbirth, during pregnancy to all future mothers it is advisable to consult a neuropathologist for identifying possible contraindications. This allows you to significantly reduce the risk of complications from anesthesia.

What is the epidural anesthesia better than general anesthesia?

The advantages of this method of anesthesia in childbirth before total anesthesia are obvious:

there is no pathological influence on the fruit (with general anesthesia, drugs have a narcotic effect on the fruit, the newborn is born with the inhibited reflexes and heavier transfers the period of postpartum adaptation);
does not affect life functions Gentlemen (unlike common anesthesia, there is no need to carry out the ventilation of the lungs using the device artificial respiratory and in medication maintenance of work of cardio-vascular system);
during the operational generics, the guinea remains conscious, sees the child immediately after his birth, can immediately listen to the assessment of his state of health;
there are problems with "output from anesthesia", often when using common anesthesia and artificial ventilation lungs when the patient does not come into consciousness for a long time and do not breathe independently;
in postoperative period Significantly shortening the period of stay in the ward intensive therapy. The woman is much earlier regenerating the strength, is activated and can independently care for the newborn.

Births are always accompanied by pain, the strength of which depends on the individual indicators. In cases strong pain and under a number of other testimony, a woman can offer to make epidural anesthesia. About what it is and what Mother and Child can threaten, we will talk.

Epidural Anesthesia - View local anesthesiawhich provides for the introduction medicinal preparation in the spine area. This area is located in the area of \u200b\u200bthe lumbar department and is called epidural space.

This kind of anesthesia is used as during natural childbirthand for cesaric sections.

For epidural anesthesia, such familiar to everyone painkillers are used: novocaine, lidocaine, ropivacaine, bupivacaine.

What is the difference from spinal anesthesia

The feminine often arises confusion associated with selection between epidural and spinal anesthesia Since the procedures are very similar. However, these methods have the following key differences:

Anesthetics are introduced into the spine, but in different parts of it. In one case, it is a subarachnoid space (liquid surrounding the spinal cord), and in the other - epidural ( fat fabric Spine preceding the subarachnoid part).
Due to the fact that drugs are introduced into different parts of the spine, they have different actions. In the spinal method, the spinal cord is blocked, and epidural sections of the nerves.
The speed of anesthesia is different: spinal anesthesia - 5-10 minutes, epiduralka - 20-30 minutes.

The administration procedure anesthetic occurs as follows:

A woman lies next to the side, curling up, or sits down, bent a little back forward. In this position, the patient must be measured and not move throughout the procedure. This will depend on the accuracy of the anesthesiologist and the likelihood of adverse effects.
The doctor processes the prolque zone by an antiseptic.
An ordinary pain relief injection is made to the lowerback area to remove the sensitivity in the place that will be punctured.
The doctor makes a puncture with a special needle. At this moment, the patient should not test the limbs, language, dizziness or nausea. If these symptoms occur, you need to immediately tell about the anesthesiologist.
Along the needle, a catheter (silicone tube) is carried out through which an anesthetic drug is introduced.
The needle is removed, and the catheter is attached to the back of the plaster and remove until the end of the birth.

At first, a small amount of anesthetic is supplied to test possible adverse reactions of the body. After the childbirth is completed and the catheter is removed, it is recommended to remain in the lying position several hours. The entire procedure for introducing a catheter takes about 10 minutes.

Anesthetics cannot penetrate the placenta, so do not affect the fruit. However, drugs include narcotic substances that penetrate the child through blood and can harm it. Many doctors tend to the fact that the impact of these substances is irrelevant and does not entail serious consequences.

On the process of childbirth epiduralka has an insignificant effect that comes down to the fact that the cervix relaxesThereby facilitating and accelerating childbirth. Often the procedure is prescribed to those women who have a mismatch of generic activity, that is, an incommary reduction in the muscles of the uterus. In this case, anesthesia helps streamline the process of childbirth.

Indications for use

A woman can be asked to spend an anesthetic procedure. But there are certain medical testimony when conducting epidural anesthesia is recommended by a doctor:

Premature childbirth (term - up to 37 weeks). Anesthesia relaxes muscles pelvic dnaAnd the premature baby is experiencing less overloads, softer passing through the generic channel.
Gestosis that increases blood pressure. Epidural helps lower pressure.
Mismatching of generic activity, which is a consequence excessive work Muscles of the uterus.
Anesthesia weakens the intensity of abbreviations and allows the muscles to relax.
Long childbirth that exhaust a woman and do not give her to relax.
Also, with a cesarean section make epidural anesthesia.

Contraindications to epidural anesthesia

Epidural anesthesia - Pretty serious procedure, which can entail serious consequences. Therefore, she has a number of contraindications:

Consequences and complications after epidural anesthesia during childbirth

Complications and unwanted consequences when carrying out such a type of anesthesia May be as follows:

Not all the patients anesthesia acts fully, therefore, the anesthesia can be partial or absent at all.
Bupivacaine can have a toxic effect on the body.
If a solid brain shell was damaged during the puncture, then cerebral fluid can find out in the epidural area. This leads to the appearance of headaches after childbirth. Such a complication can pass in a few weeks, and can stretch by year.
Too much dose of anesthetic can be toxic, which reduces the effectiveness of anesthesia.
If anesthetic substance falls through blood to the brain, then it can cause spasms and infamous.

If during the piercing was damaged nervThis can cause numbness numbers. Usually it quickly passes, but there are cases when the complication remains for life. Risk of occurrence serious complications When conducting the epidural, very low - 80,000 fever has only 1 case.

Unsuccessful epidural anesthesia

According to statistics, epidural anesthesia does not have any action in 5% of cases, and in 15% - relieves pain partially. There may be several reasons for this:

Anesthesiologist failed to get a needle in epidural space. This may be due to the inexperience of a doctor, anomalies in the structure of the spine or excessive completeness of a woman.
Due to the connecting partitions in the epidural region, the drug may apply unevenly. This leads to the fact that the pain leaves the right or left side of the body. A similar anomaly can be eliminated by increasing the dose of the drug.
Individual immunity to anesthetic. On some people, not all drugs can have an anesthetic effect.

Like any medical procedure, Epidural has its pros and cons. We will analyze them in more detail.

Benefits

The method is considered one of the strongest and reliable for pain relief.
The drug starts relatively fast - 40 minutes after installing the catheter.
The feminine remains in consciousness and feels the fight.
In some cases, such anesthesia helps generic activities: reduces pressure, relaxes the uterine muscles, gives birthday time to relax.
Can be spent cesarean sectionWhen using a stronger drug for anesthesia.

Negative sides of the procedure

For full anesthesia requires an introduction large number The drug that can adversely affect the body of the mother and child.
Anesthesia in some cases causes a strong chill, heat or itching.
Limiting mobility - a woman remains in a lying position until the end of the procedure.
To empty bladderYou will have to attach the catheter.
During the whole process of childbirth, doctors will follow the pulse of the child and constantly measure the pressure of the woman.
Because of the weakening of the bouts, it may be necessary to stimulate childbirth with oxytocin.
The need to use forceps to extract the child is increasing.
Headache or insensitivity of legs with improper piercing.

Video about epidural anesthesia during childbirth

We offer to see this video, in which it tells in detail about the impact of epidural anesthesia on a woman and child. Details told O. psychological factorsrelated to the procedure. And also listed The main disadvantages and advantages of such anesthesia.

In theory, we can talk about childbirth and the possibilities of anesthesia a lot, but what is the situation in practice? Cute mothers who passed through this procedure share with us your experience. Your help will be invaluable for those who still have to go hard, but a joyful test of childbirth.

The founders of epidural anesthesia are considered to be J.SicardiF.cathelin, which independently of each other in 1901 published the results of the introduction of a solution of cocaine throughhatussacralis (caudal anesthesia). In the same year, the tuffieryer has tried to perform epidural anesthesia in lumbar Department, but failed. In 1906, this task was spent in 1906, applying the reception proposed by them "Resistance loss" - (see below). However, only thanks to the numerous works of Italian surgeryDogliottt b. \u200b\u200bThe 19th century epidural anesthesia has won well-deserved popularity. Next iconic events In the development of the method, the glory supply. B.yuoHyv in 1944, a special needle for catheterization andj.a.lee (1960) - a labeled needle that allows you to clearly determine the depth of its administration.

In the USSR, the first epidural anesthesia was performed by B.N. Choltsov (1933). In the future, in our country, this method of anesthesia developed weakly due to the lack of special tools and the deficit of amide anesthetics. The authors can witness that even in the 70s and 1980s, our surgeons interested in this method are forced to use carmade needles of Tuoi, and as catheters use isolation from telephone wires. An important meaning was also played by the same directive direction for the implementation of all operations only under the local infiltration anesthesia according to the AV. Vischnevsky method, which prevailed in our country until the mid-70s of the twentieth century and the authority of S.Judina, who was a passionate propagandist spinal anesthesia.

Essence of the methodit consists in the introduction local anesthetic In epidural (peridural), the cellulum located between the rear wall of the spine canal and the solid cerebral shell. In epidural space there are rear spores of the spinal cord, which came beyond the limits of solid brain shell. Contacting them anesthetic turns off pain sensitivity while maintaining motor functions provided by front roots. In case of spinal anesthesia, unlike epidural, they are blocked both the front and rear spinal cord roots, due to which anesthesia and myophegia develop.

The depth of epidural space in adults in the lumbar department is 3-5 mm. Since the propagation of anesthetic in the cellulum occurs worse than in the subarachnoid space with spinal anesthesia, it is necessary to introduce large quantities of anesthetic (20 -30 ml per administration), sometimes in several intervertebral gaps.

Indications and Contraindications to Epidural Anesthesia

Indications:

Operations on organs chest, abdominal cavityurological gynecological interventions, operations on the lower limbs

Operations in patients with high anesthesia risk (obesity, cardiovascular disease, respiratory systems, diseases of the liver and kidney, elderly and senile age, "Full stomach").

Component of combined anesthesia, ensuring the blockade of pain impulsation

Postoperative anesthesia

Anesthesia with severe combined injuries with rib fractures, pelvis, bones lower extremities

Treatment of intestinal paresis with peritonitis, acute pancreatitis

Fighting chronic painful syndrome On cancer patients

Astmatic status therapy component

Absolute contraindications to epidural anesthesia:

Pnu-inflammatory diseases in the field of alleged puncture

Uncorrected hypovolemia and shock

Blood coagulation disorders (danger of epidural hematoma)
Increased intracranial pressure
The intolerance to local anesthetics
Unwillingness of the patient to be subjected to anesthesia

Relative contraindications to epidural anesthesia:

Deformation of the spine, imperative puncture

Diseases of the nervous system

Hypovolemia

Arterial hypotension

Epidural administration of narcotic analgesics increases the risk of insolvency of the anastomoses in patients with high risk This complication (oncology)

Epidural anesthesia is currently gaining increasing popularity among doctors and patients. And not in vain: such a procedure gives good efficiency and has enough contraindications.

Epidural anesthesia is considered modern method in medical practiceHowever, it was known for a long time ago. Even at the beginning of the twentieth century, experts were found that if the cocaine was introduced into the epidural space, then an excellent analgesic effect is observed. But, despite such an important scientific discovery, anesthesia for many reasons did not become widely used in medicine. About a century in the post-Soviet space, many doctors continued to use "General anesthesia", ignoring at the same time for a long time More sparing I. light method anesthesia.

On the this moment We can safely count on epidural (synonym - peridural) anesthesia, which is extensively used in abdominal surgery, oncology, traumatology and orthopedics, obstetrics, gynecology, urology and quite often - in pediatrics. So, let's find out and consider what epidural anesthesia is, as they perform this procedureWhat no side effects have, does she hurt and why this anesthesia is, not a common?

Today, this method is considered the most common in anesthesiology. How many patients choose such modern view Anesthesia, like epidural anesthesia?

If you believe the statistics, then in developed countries in Europe and the USA, they are used in 75-80% of cases.

Technique implementation

The most important task for anesthesiologist is to correctly put the catheter in epidural (peridural) space. Under epidural space there is a spinal cord, which is also surrounded by a shell (it is in this place that it is necessary to get a needle to obtain such anesthesia as spinal anesthesia).

Peridural anesthesia is carried out using a special needle (needle of touoi), which has a certain diameter (1-2 mm) and length (9 cm). Local anesthetic, falling into epidural space, blocks conducting nerve fibers that are directly related to the spinal cord. Thus, there is peridural anesthesia of one or another, depending on the level of anesthesia, the body site.

Needle Tuoi

To perform an anesthetic procedure, you must have a set for epidural anesthesia, which includes the following (additional components are possible):

needle Tuoi (epidural needle);
epidural catheter;
low resistance syringe;
connector
bacterial filter;

1 needle touoi. 2-connector with catheter. 3-bacterial filter. 4-syringe of low resistance

How do epidural anesthesia make?

Manipulation is performed by the doctor anesthesiologist and medical sister. Before the start of the procedure, the set for epidural anesthesia is laid out in a sterile tray or a sterile diaper.

The patient is in the sitting position, although the position on the side with the legs bent to the chest is allowed. The patient is asked to abnounce the back of the arc, or the "kitty" in order to make it more convenient to felt the desired benchmarks and get a needle to the necessary area. At the same time, the doctor recommends the patient not to make any movements in order to correctly and quickly perform his work.

The installation site of the catheter depends on the surgical manual (operation). This is most often a lumbar, lower chest or high chest level. The task of the doctor at this stage is a palpation method (touch with hands) to choose the desired location where the needle is entered.

The injection site is placed sterile material (pelleys, sheets, disposable aprons), only a small window in the spine area is left, which is then processed by an antiseptic. Either just back is widely processed antiseptic solution. It all depends on the materialities medical institution. Since the procedure can deliver pain in the patient, then the place first frozen the one is planted with a local anesthetic (most often it is Lidocaine). In this case, a patient can say that he cuts a little in the zone of the injection, can feel a light burning sensation that lasts long. The doctor then begins to "search" the desired space by the needle of Tuoi and the syringe low pressureand installation in this space of the epidural catheter

This step of manipulation is considered the most important and painless for the patient: under the action of the previous anesthesia, the puncture of the needle, as a rule, is practically not felt or not felt at all. Proper technique Performing requires big medical mastery to successfully conduct such a procedure as epidural anesthesia.

When the needle fell into the necessary area, a catheter is introduced through it. Through this thin tube, a drug will be supplied to perform anesthetic action. The patient at this stage also does not feel any discomfort.

After installing the catheter in the spine, the needle is extracted. Further, the connector (adapter) is connected to it so that you can enter the desired drug with a syringe.

Before entering a complete dose of anesthetic, the doctor introduces a "test dose". This is one of additional methods To confirm the correct location of the epidural catheter. For this, several milliliters of the drug are introduced and its impact is made. At this time, the doctor will ask questions, ask for certain actions. It is very important that the patient gives clear answers and performed all the actions of the doctor. From this will depend on the quality of anesthesia. The catheter is reliably fixed with a sterile dressing and leucoplasty. Many patients ask: "How much time passes before I feel the action of medication and anesthesia?". Anesthesia action is manifested in 15-25 minutes.

Indications for epidural anesthesia:

performing operational interventions on breast cavity, abdominal cavity, on the lower limbs;
in complex therapy Some diseases (for example, pancreatitis)
treatment of chronic and protracted pains;
anesthesia of childbirth;
obstetric readings;

Contraindications for peridural (epidural) anesthesia.

So, the contraindications can be absolute (do not allow the patient to anesthesia in 100% cases) and relative (at the discretion of the doctor).

Absolute contraindications:

patient failure;
skin diseases of the back with severe membrane jackets and formations at the point of puncture (injection);
allergic reaction to local anesthetic;
pronounced deformation spinal column (for example, Bekhter's disease);
violation of blood coagulation (coagulopathy);
Clinically significant hypovolemia (dehydration, blood loss);
Violation of the conductivity of the heart (AV-blockade, sinus node weak syndrome);

Relative contraindications:

developmental anomalies and light deformation of the spine;
psychiatric diseases;
Low level of intellect in the patient;
Treatment with disaggregants and anticoagulants - drugs "thinning blood" (clopidogrel and its derivatives, warfarin, etc.);
Transferred early operation on the spine;
The presence of a tattoo at the point of puncture (injection);

Pros and Cons Anesthesia

As mentioned above, peridural anesthesia today has a high relevance. This species Anesthesia has much less side effects on the body, unlike general anesthesia (anesthesia)

However, every medal has back side. It will be about complications

Complications of epidural anesthesia:

epidural anesthesia does not bring the desired effect, so partial blockade may be observed or it will not be at all (there will be no pain relief);
the formation of hematoma in epidural space-rather rare complication;
infection in the peridural space is rarely found;
toxic effect of drugs due to unintentional in \\ in the introduction of a local anesthetic or an overdose of the drug due to the exceedable dose of the drug;
Headaches different intensity. This may occur with an unintentional puncture of the spin-mode spinning space. Needle Tuoi (most frequent complication)
Various neurological disorders - from the lungs (partial paralysis / numbness, pain in the legs) to coarse (damage to the spinal cord) - are very rare;
Catheter cutter (as the catheter is a plastic tube, then it can be broken hypothetically! Depending on the level on which the catheter broke out, it may be necessary surgery According to his "capty". For example, if it happened at the level of the skin. In other cases, the catheter is left, as it is absolutely compatible with the surrounding tissues);
Back pain (due to the fact that anesthesia causes muscle relaxation and tensioning of ligaments, occurs approximately 40% of patients, passes after 1-2 days, cases of a longer presence of pain are described, which is due to the exacerbation of existing spinal problems) ;
Error Introduction Not intended for epidural administration drug (no matter how strange it did not sound, but it takes place, although quite rarely)

Epidural anesthesia is one of the ways of facilitating the state of a woman during childbirth. Many women, this process scares with their soreness, but modern medicine offers several methods to eliminate this phenomenon.

What is epidural anesthesia?

In the lumbar vertebral post, in epidural space, come out spinal roots For which the transmission of nerve impulses from the abodes of a small pelvis, including the uterus.

The injection of special drugs blocks these pulses, as a result of which the woman ceases to feel the contractions. An anesthesiologist counts the dose so that the sensitivity disappears below the belt, but at the same time a woman can move independently and is in consciousness.

The action of anesthetics applies only to the contractions, that is, for the period, the opening of the cervix. Further attempts and the passage of the baby in the generic paths are not anesthetized.

The difference of the spinal procedure and epidural anesthesia

Very often two of these events are confused. Indeed, at first glance, they are no different. But when conducting a spinal anesthesia, use a thinner needle and introduced active substance In the spinal fluid slightly below the spinal cord level. As a result, drugs act a little differently than in epidural anesthesia.

It is worth noting that the latter is more secure in terms of possible complications.

Features of the procedure

The procedure consists of the following steps:

A woman sits down with a bent back or licking a message, coating with "Kalachik". Pose should provide maximum access to the spine. It is important not to move during a puncture and be ready for it. At that moment a small discomfort will appear, but it is impossible to remove from the doctor. If a woman does not move, thereby reducing the risk of complications;
The area where puncture is supposed to be processed by an antiseptic;
Then make the injection of anesthetic to eliminate the sensitivity of the skin and subcutaneous fatty fiber;
After that, the anesthesiologist does the puncture itself and introduces the needle to the brain shell;
A thin silicone tube is carried out on the needle - catheter. It is on it that anesthetics will come to epidural space. The catheter is left in the back at the time you need. During childbirth, it is not taken out. When it is inserted, it may occur "races" in the leg or back, which occurs due to the root of the root of the nerve tube;
After the catheter is inserted, the needle is removed, and the tube is fixed on the back of the leukoplasty;
Then the minimum dose of the drug is administered to test the adequacy of the body's reaction (absence of allergies);
After the birth of a child, the catheter is removed, and the puncture is jammed again with adhesive plane. The woman will have to lie down a little longer so that any complications do not arise.

Anesthetic drugs can be introduced in two methods: continuously, that is, after certain intervals, but minimal doses; One once, after performing a repeat after 2 hours, if necessary.

Unlike the first option, when you can walk in a few minutes, in the second case, the woman should take a sudden position, because the vessels of the legs and the outflow of blood can lead to the loss of consciousness when rising.

Anesthesia is carried out with the use of lidocaine, novocaine or bupivacaine. They do not penetrate the placental barrier.

Preparation, contraindications and indications for the procedure

Epidural anesthesia set includes: epidural needle and appropriate catheter, disposable syringes, bacterial filter, special device To enter anesthetic from the syringe to the catheter.

If the procedure has arisen easy sensationsFor example, there are no legs or tongues, began to sick, then it is necessary to inform you about it to your anesthesiologist, because such phenomena should not be. When a woman feels that the fight is about to begin, it should also warn a specialist. He will stop and say, while she is over.

The process itself takes no more than 10 minutes. Anesthetics will begin to act another 20 minutes. One of the points of interest is the pain of the procedure. It is worth noting that it causes only small unpleasant sensations that can be tolerated, because they last just a few seconds. The catheter also does not cause discomfort, even when driving.

Indications for anesthesia: premature pregnancy, anomalies of labor activities, an increase in blood pressure, the impossibility of common anesthesia, the process of childbirth continues for a long time, the need for surgical intervention.

Among the contraindications are the following: increased cranial or low blood pressure, deformation of the spine, impeding access for the catheter, inflammation in the region of the intended puncture, a violation of blood coagulation or infection, a reduced number of platelets, individual intolerance, the unconsciousness of the feminine, psychoneurological disorders, a number of diseases of cardiovascular Vascular system and refusal of anesthesia.

The consequences and complications of epidural anesthesia after childbirth

Fit medication drugs into blood. There are many veins in epidural space, therefore the risk of penetration of anesthetics in the bloodstream is increased. When it happens, the woman feels nausea, dizziness, weakness, a strange taste in the mouth, there is numbness of the tongue. If such states appear, you need to urgently access the doctor, since they should not be;
Allergy. It is possible that after the introduction of anesthetic will arise anaphylactic shockThat is, there will be a failure in the work of vital organism. This can happen if the woman has never docked in life with such substances and does not know about its negative reaction to them. To exclude such consequences, at first the doctor introduces the minimum dose and carefully monitors the state of a woman;
Difficulties with breathing. Pretty rare socialitywhich occurs due to the action of an anesthetic drug on the nerves leading to intercostal muscles;
Back pain. The most common gutter after such a procedure. Soreness arises as a result of a cerebral claroper and entering the epidural space of a small amount of spinal fluid. Typically, pains pass a day later, but many patients claim that they can be observed for several months;
Headaches. They arise for the same reason as back pain. To eliminate these two unpleasant effects Use drugs or repeat the puncture with the subsequent introduction of the blood of the woman itself, which will block the puncture;
Lowering blood pressure. "Flies" may arise before their eyes, suddenly begin nausea and even vomiting. To prevent such effects, they put droppers. After performing anesthesia, the feminine should not stand throughout the time-installed time;
In some cases, the difficulties of urination arise;
Most. hazardous complication is paralysis of the lower extremities. This is a rather rare situation, but still it is not worth excluding it from possible risks.

In about 20% of cases, the anesthesia does not occur at all or is observed, but partially. Such moments are explained by several factors. For example, when conducting a procedure in an inexperienced specialist, although often beginners do not allow such manipulations, in obesity of the lady and the anomalies of the spine.

Sometimes the so-called mosaic anesthesia occurs, that is, sensitivity disappears only on one side of the body. Such a defect is explained by the fact that partitions in epidural space prevent the penetration of anesthetics. Anesthesiologist will increase the dose, will make another injection or will advise turning on the other side.