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Dr.Erniody,Sp.An.,KIC.,M.Kes.
Revised: 3 September 2016
33 vertebrae total:
7 CERVICAL (labeled C1 - C7)
12 THORACIC (labeled T1 - T12)
5 LUMBAR (labeled L1 - L5)
5 FUSED to form the SACRUM (labeled S1 – S5)
4 COCCYGEAL
Spinal anaesthesia is a technique whereby a local
anaesthetic drug is injected into the cerebrospinal fluid.
- Check for lower limb weakness as an early indicator that the
injection was correct.
- Inability to straight leg raise suggests the block will cover at
least all the lumbar segments.
After the initial dose, one quarter to one third of the amount
can be administered 10–15 min later to intensify the sensory
block. The overall level of the block will not be significantly
increased with this method.
Motor block:
2
dermatomes
lower than
sensory
block
• Failure to achieve analgesia or anaesthesia occurs in about
5% of cases, while another 15% experience only partial
analgesia or anaesthesia.
• Blok unilateral dapat terjadi bila obat diberikan lewat
kateter yang keluar dari ruang epidural menarik
kateter 1-2 cm dan disuntikan ulang dimana pasien
diposisikan dengan bagian yang belum terblok berada
disisi bawah.
• Epidural placement is a safe, effective --> providing
surgical anesthesia or postoperative analgesia.
• It has the benefit of being used for segmental
blocks or for more complete motor–sensory blocks
necessary for surgery.
• It reduces the adverse physiologic responses to
surgery --> decrease the incidence of myocardial
infarctions and postoperative pulmonary sequelae,
and can reduce the incidence of hypercoagulable
events.
• The complications associated with intubation and
general anesthesia are avoided.
Clinical Pearl:
• Epidural catheter can be placed:
Heparin subcutaneous: 4h after the last
dose
• LMWH should be held at least:
12 h before placement of catheter
2 hour after removal
• If an epidural vein is punctured:
subcutaneous heparin should be held at
least 2 h
LMWH held at least 24 h
• Epidural placement should be avoided:
Zero for aspirin
3-5 days after warfarin
5-7 days after clopidogrel
14 days after ticlopidine
• GIIa/IIIb inhibitors should be withheld for at
least 4 weeks after epidural placement.
• Epidural placement is relatively safe with
INR < 1.5
The time from epidural catheter removal to
anticoagulant drug administration is at least:
- 24 hrs for warfarin
- 2 hrs for low dose heparin
- 6-8 hrs for LMWH.
Thank Q