Epidural nerve block

Commonly performed as a sole procedure or in combination with spinal or general anesthetic.

The procedure can increase the duration of anesthesia or analgesia.

The procedure enables patients to control their pain with patient-controlled epidural analgesia (PCEA) in a manner similar manner to that of intravenous patient-controlled analgesia (IV PCA).

Local anesthetic epidural blockade may be useful in management of a painful limb associated with joint stiffness or limited range of motion.

Epidural blocks, and epidural injections of local anesthetic, steroids, or both are considered for the treatment of radicular pain symptoms secondary to disk herniation or postsurgical radicular pain.

Epidural injections offer effective pain relief in selected patients.

Epidural injections/block may be performed in the spinal region, including the cervical, thoracic, lumbar, and sacral regions.

Epidural injections are delivered using midline, paravertebral, or transforaminal approaches.

Long-term epidural catheters are helpful in managing severe pain in cancer and noncancer chronic pain conditions.

Epidural local anesthetic can provide sympathetic blockade.

The cephalad part of the spinal epidural space begins at the level of foramen magnum.

The caudal part of the spinal epidural space extends to the sacrococcygeal membrane.

The anterior epidural space is formed by the posterior longitudinal ligament.

The posterior longitudinal ligament covers the posterior part of the vertebral body and the intravertebral disk.

Posteriorly, the epidural space is formed by the anterior lateral surface of the vertebral lamina and the ligamentum flavum.

Laterally, the epidural space is formed by the pedicles of the vertebrae and the intravertebral foramen.

The ligamentum flavum is the key landmark for identification of the epidural space.

The ligamentum flavum is thinnest in the cervical region, and the epidural space is narrowest in the cervical region, with an anterior/posterior diameter of 2-3 mm.

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