tailieunhanh - Ebook Hadzic’s textbook of regional anesthesia and acute pain management (2/E): Part 2

Part 2 book “Hadzic’s textbook of regional anesthesia and acute pain management” has contents: Epidural anesthesia, caudal anesthesia, combined spinal and epidural anesthesia, postdural puncture headache, ultrasound-guided head and neck nerve blocks, and other contents. | 380 SECTION 2 Epidural Anesthesia CHAPTER 24 Epidural Anesthesia and Analgesia Roulhac D. Toledano and Marc Van de Velde* INTRODUCTION Clinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. Epidural analgesia is often used to supplement general anesthesia (GA) for surgical procedures in patients of all ages with moderate-tosevere comorbid disease; provide analgesia in the intraoperative, postoperative, peripartum, and end-of-life settings; and can be used as the primary anesthetic for surgeries from the mediastinum to the lower extremities. In addition, epidural techniques are used increasingly for diagnostic procedures, acute pain therapy, and management of chronic pain. Epidural blockade may also reduce the surgical stress response, the risk of cancer recurrence, the incidence of perioperative thromboembolic events, and, possibly, the morbidity and mortality associated with major surgery. This chapter covers the essentials of epidural anesthesia and analgesia. After a brief history of the transformation from single-shot to continuous epidural catheter techniques, it reviews (1) indications for and contraindications to epidural blockade; (2) basic anatomic considerations for epidural placement; (3) physiologic effects of epidural blockade; (4) pharmacology of drugs used for epidural anesthesia and analgesia; (5) techniques for successful epidural placement; and (6) major and minor complications associated with epidural blockade. This chapter also addresses several areas of controversy concerning epidural techniques. These include controversies about epidural space * The authors would like to thank Michael A. Maloney, MB, BAO, ChB, for his help with the tables and figures. 380 anatomy, the traditional epinephrine test dose, methods used to identify the epidural space, and whether particular clinical outcomes may be improved with epidural techniques when compared to GA.