Epidural Anesthesia

Excerpt

Epidural anesthesia is a method of neuraxial pain control in which anesthetic medications are injected into the epidural space to block sensory and motor spinal nerve roots in the thoracic, abdominal, pelvic, and lower extremity areas. This epidural technique can be used for anesthesia during procedures, chronic pain, or muscle spasticity as a primary anesthetic or pain management adjuvant. Epidural anesthesia has been an effective modality for pain control for more than 100 years, with many proven advantages over other forms of anesthesia. A primary advantage epidural anesthesia offers is the ability for clinicians to tailor the medication used and the type of administration (ie, intermittent or continuous infusion) to meet the clinical need. Additionally, this technique can reduce the opioid requirement during and after a procedure, lowering the incidence of associated side effects. This is particularly relevant in pediatric anesthesia, where the potential negative impact of certain anesthetic drugs on neurodevelopment is debated. The epidural technique is also valuable for postoperative pain management as part of a multimodal approach. A recent benefit of epidural anesthesia was providing an alternative to aerosol-generating general anesthesia during the COVID-19 pandemic.

However, recent studies have argued that alternative anesthesia techniques may benefit more and are less invasive than epidural anesthesia. Furthermore, several complications and risks are also associated with the epidural procedure. Therefore, healthcare professionals need enhanced competence in recognizing the indications and contraindications for epidural anesthesia and the risks, benefits, and complications involved. Additionally, clinicians should have knowledge of the current techniques recommended for performing epidural anesthesia and the role of the interprofessional team in caring for patients who undergo the procedure to optimize outcomes.