neuraxial

Neuraxial refers to the neuraxis, the axis of the central nervous system that includes the brain and spinal cord, and to procedures or anesthesia delivered near these structures within the vertebral canal. In medical practice, neuraxial anesthesia or neuraxial analgesia denotes regional techniques in which local anesthetic agents are introduced near the spinal cord to block nerve transmission.

Common neuraxial techniques include epidural anesthesia and spinal anesthesia. Epidural anesthesia/analgesia involves injecting a local anesthetic into the epidural space, often via a catheter for ongoing analgesia or anesthesia. It is widely used for labor and for various surgical procedures, with the ability to titrate effect and extend duration. Spinal anesthesia, or intrathecal anesthesia, consists of a single-dose injection of local anesthetic into the subarachnoid space, producing rapid and reliable sensory and motor blockade for lower abdominal, pelvic, or lower limb procedures. Caudal anesthesia, a form of epidural anesthesia delivered through the sacral hiatus, is commonly used in pediatric patients. A combined spinal-epidural technique can provide the rapid onset of spinal anesthesia with the flexibility of an epidural catheter for prolonged analgesia.

Indications include obstetric analgesia during labor, anesthesia for lower abdominal, pelvic, or orthopedic surgery, and postoperative pain management. Benefits include targeted regional effect with reduced systemic drug exposure and potential improvements in maternal and fetal safety during appropriate procedures. Potential complications may include hypotension, post-dural puncture headache, infection, hematoma, nerve injury, urinary retention, and accidental dural puncture. Contraindications include patient refusal, infection at the injection site, coagulopathy, and certain spinal abnormalities.