Spinal, Epidural,& Caudal Blocks
Spinal, caudal, and epidural blocks were first used for surgical procedures at the turn of the twentieth century. These central blocks were widely used worldwide until reports of permanent neurological injury appeared, most prominently in the United Kingdom. However, a large-scale epidemiological study conducted in the 1950s indicated that com-plications were rare when these blocks were per-formed skillfully, with attention to asepsis, and when newer, safer local anesthetics were used. Today, neuraxial blocks are widely used for labor analgesia, caesarian section, orthopedic proce-dures, perioperative analgesia, and chronic pain management. However, they are still associated with various complications, and much literature has examined the incidence of complications fol-lowing neuraxial blocks associated with different disease states. Additionally, various organizations continue to issue “guidelines” related to the man-agement of regional anesthesia.Neuraxial anesthesia greatly expands the anesthesiologists’ armamentarium, providing alternatives to general anesthesia when appropriate. Neuraxial anesthesia may be used simultaneously with general anesthesia or after-ward for postoperative analgesia. Neuraxial blocks can be performed as a single injection or with a catheter to allow intermittent boluses or continu-ous infusions.
Neuraxial techniques have proved to be safe when well managed; however, there is still a risk of complications. Adverse reactions and complications range from self-limited back soreness to debilitat-ing permanent neurological deficits and even death. The practitioner must therefore have a good under-standing of the anatomy involved, be thoroughly familiar with the pharmacology and toxic dosages of the agents employed, diligently employ sterile tech-niques, and anticipate and quickly treat physiologi-cal derangements.
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