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Epidural anaesthesia 

Epidural anaesthesia
Chapter:
Epidural anaesthesia
Author(s):

Rafal Baraz

and Paul Clyburn

DOI:
10.1093/med/9780199572144.003.0008
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date: 16 December 2017

Epidural anaesthesia is safe if inserted by a skilled practitioner where adequate monitoring and resuscitation can be provided

Epidural anaesthesia requires good understanding of: the anatomy of the back and spine, physiological changes of pregnancy and the pharmacological effects of local anaesthetics

Correct positioning of the mother is crucial to the success of epidural insertion

It is very important to keep control of the epidural needle at all times during insertion

Withdrawing the catheter through the epidural needle may shear the catheter. The catheter and needle should be removed as one unit

Accidental dural puncture is an important complication

Aspirating CSF through an epidural catheter is sometimes difficult and dural puncture by the catheter can be easily missed

Test doses increase the safety of epidural anaesthesia and must be employed at all times

Following accidental dural puncture, all top-ups must be given by an experienced anaesthetist.

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