puncture epidural space

There are two types of puncture in the epidural space: straight and lateral. Because the spinous processes of the waist are parallel, the straight-in method is generally advocated.

The lateral approach is only used when the direct penetration is difficult, the elderly, the supraspinous ligament is calcified, the spinal curvature is limited, or the gap cannot be touched.

0. Select the correct lumbar intervertebral space for the direct insertion method, remove the local skin, lay a sterile towel on the upper and lower sides, and use local anesthetic to moisten the skin and various layers of tissue through the midline of the waist. It is round and blunt, so the range of infiltration block should be wide enough. Then use a skin incision needle to poke a hole in the skin mound, and then use an epidural piercing needle to insert the person, hold the needle body with one hand against the back, and push the needle slowly with the other hand. The ligaments of the ligaments are completely parallel to each other to avoid excessive damage to the ligament fibers. During the whole puncture process, the level of the ligament should be understood according to the change of resistance. After the supraspinous ligament is passed, the interspinous ligament is relatively loose, and the resistance of needle insertion is small at this time. > Continue to advance to encounter the dense and thick ligamentum flavum. When the needle tip passes through the ligamentum flavum and enters the epidural space, the resistance can increase to disappear suddenly, that is, there is a "feeling of failure". It is preliminarily judged that the needle tip has reached the epidural space.

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