Epidural and Spinal Analgesia Quiz

Study Notes

Epidural and Spinal Analgesia

Commonly used for labor and delivery.
Local anesthetics alone or with opioids.
Neural blockade at T10-L1 for first stage of labor.
Neural blockade at T10-S4 for second stage of labor.
Effective methods:
- Programmed intermittent epidural bolus (PIEB).
- Continuous epidural analgesia.
- Suitable for first and subsequent stages of labor.
- "Single-shot" epidural, spinal, or combined techniques offer timely pain relief.

Caudal Injections

Largely abandoned due to lack of versatility and higher volume requirements for broad coverage, increasing risk.
Effective for perineal analgesia but can cause early paralysis of pelvic muscles, interfering with fetal head rotation and increasing the risk of accidental fetal puncture.

Absolute Contraindications

Patient refusal.
Infection at the injection site.
Coagulopathy.
Marked hypovolemia.
True allergies to the chosen local anesthetic.
Inability to cooperate with the procedure.

Other Risks

Anticoagulation: Markedly increases the risk of neuraxial anesthesia. Avoid within 4-6 hours of unfractionated heparin, 10-12 hours of low-molecular-weight heparin (LMWH).
Thrombocytopenia: Use with caution in patients with thrombocytopenia or antiplatelet drug administration to reduce the risk of spinal hematoma.
VBAC (Vaginal Birth After Cesarean): Not a contraindication to regional anesthesia. Uterine rupture may not always be painful and can be masked by anesthesia. Changes in uterine tone are more reliable signs of rupture.

Necessary Equipment

Resuscitation equipment: Oxygen, suction, face-mask with positive pressure device, laryngoscope, blades, endotracheal tubes (6 or 6.5mm), oral and nasal airways, intravenous fluids, ephedrine, atropine, propofol, and succinylcholine.
Monitoring equipment: Pulse oximeter, capnography for monitoring blood pressure and heart rate.
Difficult airway management: Video laryngoscope or intubating laryngeal mask airway device must be immediately available.

Lumbar Epidural Analgesia

Can be administered in early labor.

Description

Test your knowledge on epidural and spinal analgesia techniques, commonly used for labor and delivery. This quiz covers effective methods, contraindications, and specific nerve blockade levels. Perfect for students and professionals in the medical field.