epidural anesthesia during laborby:

Asmaa Mashhour Eidsupervised:

Dr Aida Abd El -Razek

Objective1- Anatomy of epidural space2- definition of epidural anesthesia during labor3- explain indication of epidural4- list contraindications5- Described positions epidural anesthesia and timing

6-list technique for administration before and after given7- list advantages8- list disadvantages9-summarzd10- reference

Anatomy of epidural spacethe nerves in the spinal cord are

protected by several tissue layers the pia mater is the membrans adhering to the nerves fiber surrounding this is the

cerebrospinal fluid (csf) next comes the arachniod

membrans and outside that tha dura

mater

Definitionanesthetic agent placed in the epidural space at the L4-L5 or L3-L4 interspace block spinal nerve root and sympathetic

nerve fiber

IndicationsRelief from the pain of uterine contractions and birth during

laber

Contraindications to epidural block1.Active antepartum hemorrhage

(Acute hypovolemia leads to increased sympathetic tone to

maintain the blood pressure , any anesthetic technique the blocks the

sympathetic fiber can produce significant hypotension that can endanger the mother and baby

2.Anticoagulant therapy or bleeding disorder3.Infection at the injection site infection can be spread through the peridural or subarachnoid spaces if the needle traverses an infected area4.Allergy to the anesthetic drug5.maternal refusal

positions epidural anesthesia and timing

between L4-L5 or L3-L4when the cervix is dilataed 5 to

6 cm

Technique for Administration before1- cervix is dilataed 5 to 6 cm 2-IVinfusion and equipment for blood pressure should be in place3-help position the woman on her side or sitting upright4-the lumbar area of the back is cleaned antiseptic solution

Cont5-local anesthetic is injected into the skin to form a wheal over the L3 and L4 vertebrae 6- a special 3to 5 inch needle is than passed through the L3-L4 interspaceinto the epidural space

Cont7-polyethylen catheter is passed through the needle into the space and needle is then withdrawn8-leaving the catheter to be

taped in place

Technique for Administrationafter1-asses the woman pulse and blood pressure2-the effect of epidural anesthesia is short lived (40 minutes to 2 hours)

Advantages of an epidural;

1.The woman remains alert and able to participate2.good relaxation is achieved3.airway reflexes remain intact 4. blood loss is not excessive5.gastric emptying is not delayed

The disadvantages of epidural;1.The woman ability to move freely is limited related to use of an IV infusion 2.orthostatic hypotension 3.dizziness4.weakness of the legs 5.sedation6.bizarre behavior

7.Tinnitus8.disorientation9.paresthesia10.Respiratory arrest can occur if the relatively high dosage

Summary- epidural anesthesia during labor Relief from the pain of uterine contractions and birth - Contraindications to epidural block - positions epidural

-Technique for Administration before and after- list advantage-list disadvantages

ReferenceBook (maternal and child health

nursing)fifth edition

(Adele pillitteri)pags (551,554, 553)