neuraxiale

Neuraxiale is an adjective used in medicine to describe anything relating to the neuraxis, the axis of the central nervous system that includes the brain and spinal cord. In clinical practice, the term is often applied to neuraxial anesthesia or analgesia, which are regional techniques delivered by injection near the spinal cord.

Anatomy and spaces: The neuraxial spaces comprise the subarachnoid space, where intrathecal (spinal) injections are given, and the epidural space, outside the dura mater, where epidural injections and catheterization occur. A variation used in pediatric patients is caudal anesthesia, accessed through the sacral hiatus.

Techniques and modalities: Spinal anesthesia involves a single intrathecal injection of local anesthetic into the subarachnoid space, often with adjuvants. Epidural anesthesia entails placing a catheter in the epidural space for ongoing analgesia or anesthesia. Caudal anesthesia is an epidural approach via the sacral region. Combined spinal-epidural anesthesia employs both methods to achieve rapid onset with flexible, extended analgesia through the epidural catheter.

Indications and applications: Neuraxial techniques are widely used for obstetric anesthesia, including labor analgesia and cesarean delivery, as well as for lower abdominal, pelvic, hip, and leg surgeries. They offer targeted regional anesthesia with reductions in systemic drug exposure and certain airway management advantages in specific populations.

Safety and contraindications: Neuraxial procedures are contraindicated in cases of patient refusal, infection at the insertion site, increased intracranial pressure, uncorrected coagulopathy or significant anticoagulation, and certain spinal deformities. Potential complications include hypotension from sympathetic block, post-dural puncture headache, back pain, infection, hematoma, nerve injury, catheter malposition, or local anesthetic systemic toxicity.