Overview of neuraxial anesthesia
- Unyime Ituk, MBBS, FCARCSI
Unyime Ituk, MBBS, FCARCSI
- Associate Professor of Anesthesia
- University of Iowa
- Cynthia A Wong, MD
Cynthia A Wong, MD
- Professor of Anesthesia
- University of Iowa Healthcare
Neuraxial anesthesia and analgesia techniques include spinal, epidural, and combined spinal epidural. This topic will discuss aspects of neuraxial anesthesia (NA) that are common to all of these techniques, and the differences among them. The techniques for performing each of them are discussed separately. (See "Spinal anesthesia: Technique" and "Epidural and combined spinal-epidural anesthesia: Techniques".)
Neuraxial procedures for chronic pain conditions (eg, spinal cord stimulator, epidural steroid injections) are also discussed separately. (See "Spinal cord stimulation: Placement and management" and "Subacute and chronic low back pain: Nonsurgical interventional treatment", section on 'Epidural injection'.)
Neuraxial anesthesia is performed by placing a needle between vertebrae and injecting medication into the epidural space (for epidural anesthesia) or the subarachnoid space (for spinal anesthesia). The anatomy relevant for neuraxial anesthesia techniques is discussed in detail separately. (See "Spinal anesthesia: Technique", section on 'Anatomy' and "Epidural and combined spinal-epidural anesthesia: Techniques", section on 'Anatomy'.)
USE OF NEURAXIAL ANESTHESIA
Neuraxial anesthesia (NA) is most commonly used for lower abdominal and lower extremity surgery (table 1). The sensory level required for a specific surgery is determined by the dermatome level of the skin incision and by the level required for surgical manipulation; these two requirements may be very different. As an example, a low abdominal incision for cesarean delivery is made at the T11 to T12 dermatome, but a T4 spinal level is required to prevent pain with peritoneal manipulation (figure 1 and table 2).
Spinal, epidural, and combined spinal-epidural (CSE) anesthesia can be used for many of the same surgical procedures. Differences among them may affect the choice of technique for a specific procedure or patient. The advantages and disadvantages of the various neuraxial anesthesia techniques are shown in a table (table 3). Spinal anesthesia is usually administered as a single injection, whereas epidural anesthesia is usually administered via a catheter for continuous infusion, and CSE anesthesia combines the two. Continuous spinal anesthesia via a catheter sited in the subarachnoid space is less commonly used than the other techniques. (See "Spinal anesthesia: Technique", section on 'Continuous spinal'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- USE OF NEURAXIAL ANESTHESIA
- PREOPERATIVE EVALUATION
- Laboratory evaluation
- PHYSIOLOGIC EFFECTS OF NEURAXIAL ANESTHESIA
- Central nervous system
- ADVERSE EFFECTS AND COMPLICATIONS
- High or total spinal anesthesia
- Subdural injection
- Nerve injury
- Back pain
- Postdural puncture headache
- Urinary retention
- Transient neurologic symptoms
- Local anesthetic systemic toxicity
- Spinal-epidural hematoma
- GENERAL VERSUS NEURAXIAL ANESTHESIA
- SUMMARY AND RECOMMENDATIONS