Epidurala

Epidurala, commonly known as epidural, refers to the epidural space surrounding the spinal cord and to medical procedures that access this space for analgesia or anesthesia. The term is used in several languages to describe both the anatomical space and the techniques that target it.

Anatomy and access: The epidural space lies between the dura mater and the walls of the vertebral canal, extending from the foramen magnum to the sacral region. It contains fat, small arteries and veins, and nerve roots. Clinically, the space is usually accessed in the lumbar region, most often at the L2–L3 or L3–L4 interspace, using a needle to place a catheter that can deliver continuous medication.

Medical uses: Epidural anesthesia and analgesia are widely used for labor and delivery, as well as for anesthesia or postoperative pain control in lower abdominal, pelvic, and limb surgeries. Epidural steroids injections are used for certain types of radicular back pain and inflammation, though this is distinct from anesthesia. When a catheter is placed, ongoing doses of medication can provide sustained relief or anesthesia.

Techniques and pharmacology: Epidural blocks involve injecting local anesthetics, with or without opioids, into the epidural space. Common agents include bupivacaine, ropivacaine, and lidocaine, often combined with fentanyl or morphine to enhance analgesia. Dose, concentration, and infusion rate are tailored to the clinical goal and patient factors.

Risks and considerations: Potential complications include dural puncture with post-dural puncture headache, hypotension due to sympathetic blockade, infection, epidural hematoma, and rare nerve injury. Contraindications include patient refusal, infection at the injection site, coagulopathy, and certain neurological or spinal conditions. Proper monitoring and technique are essential to minimize risk.