Update on applied epidural anatomy

Macpherson, Duncan; Quondamatteo, Fabio; Broom, M.

doi:10.1016/j.bjae.2021.12.006

Cited by 5 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is currently no clear evidence on the risk of neuraxial analgesia procedures in subsequent pregnancies in women who have previously suffered ADP/PDPH. A proportion of women may have predisposing risk factors for suffering ADP, with anatomical studies showing that midline fusion of the ligamentum flavum is absent in up to one-third of cadavers in at least one vertebral level [15]. Given that there are viable alternatives to labour neuraxial analgesia (i.e.…”

Section: Medium-longer-term Maternal Effects Of Neuraxial Analgesia I...mentioning

confidence: 99%

Long-term effects of neuraxial analgesia

Kearns,

Broom,

Lucas

2024

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of review This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. Recent findings Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve. For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. Summary Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.

show abstract

Section: Medium-longer-term Maternal Effects Of Neuraxial Analgesia I...mentioning

confidence: 99%

Long-term effects of neuraxial analgesia

Kearns,

Broom,

Lucas

2024

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Mice, rats, and other tetrapods have two adjacent upper parts of the epidural space: the first is the bony part (i.e., the vertebral arch (inside a single vertebra)), and the second is the connective tissue part (i.e., ligament flavum (intervertebral space)). It is filled with loose connective tissue, epidural fats, veins, arteries, internal vertebral venous plexuses, spinal nerve roots, and lymphatics [21] (Figures 1-3).…”

Section: Epidural Spacementioning

confidence: 99%

Epidural and Intrathecal Drug Delivery in Rats and Mice for Experimental Research: Fundamental Concepts, Techniques, Precaution, and Application

2023

View full text Add to dashboard Cite

Epidural and intrathecal routes are the most effective drug administration methods for pain management in clinical and experimental medicine to achieve quick results, reduce required drug dosages, and overcome the adverse effects associated with the oral and parenteral routes. Beyond pain management with analgesics, the intrathecal route is more widely used for stem cell therapy, gene therapy, insulin delivery, protein therapy, and drug therapy with agonist, antagonist, or antibiotic drugs in experimental medicine. However, clear information regarding intrathecal and epidural drug delivery in rats and mice is lacking, despite differences from human medicine in terms of anatomical space and proximity to the route of entry. In this study, we discussed and compared the anatomical locations of the epidural and intrathecal spaces, cerebrospinal fluid volume, dorsal root ganglion, techniques and challenges of epidural and intrathecal injections, dosage and volume of drugs, needle and catheter sizes, and the purpose and applications of these two routes in different disease models in rats and mice. We also described intrathecal injection in relation to the dorsal root ganglion. The accumulated information about the epidural and intrathecal delivery routes could contribute to better safety, quality, and reliability in experimental research.

show abstract

“…Furthermore, the epidural space is in connection with the paravertebral space and attached anatomical structures. Thus, the epidural space is neither a distinct anatomical compartment nor a homogeneous compartment [12]. Disk herniation (the most common chronic disease of the spine) occurs primarily at weak points in this posterior longitudinal ligament in an area that comprises the anterior epidural space, as opposed to the more clinically relevant posterior epidural space [12].…”

Section: "Back To Basics" 21 Anatomy Of Epidural Spacementioning

confidence: 99%

“…Because the plexus is valveless, blood from any of the connected systems can flow into the epidural vessels. Therefore, in situations when caval flow is obstructed, as in late pregnancy, the spinal veins are distended and occupy an abnormal absorption of the spinal canal [11,12].…”

Section: "Back To Basics" 21 Anatomy Of Epidural Spacementioning

confidence: 99%

See 1 more Smart Citation

Physiology and Pharmacology of Epidurally Administered Drugs

Brusich¹,

Valenčić²,

Polonijo³

2023

Epidural Administration - New Perspectives and Uses

View full text Add to dashboard Cite

In the last few decades, epidural administration of various drugs has gained popularity and widespread clinical acceptance. Epidural administration of local anesthetics and opioids has been considered “state of the art” in acute pain management (thoracic and major abdominal surgery, labor). Its advantage is that it yields profound, long-lasting, dose-dependent analgesia, leaving other sensory and motor functions intact. It facilitates early patient mobilization and ambulation and therefore reduces the risk of postoperative thromboembolism and respiratory complications. The increment in the elderly population caused an increase in musculoskeletal and spine diseases and thus, epidural steroid injections have become highly effective for chronic pain treatment. There are many factors that have an impact on drug physiology and pharmacology in the epidural space and, therefore, can modify epidural anesthesia or the expected effect of another medication. This chapter provides insight into this complex and comprehensive topic to demonstrate a predictable pattern that can provide a safe and accurate guide to clinical practice.

show abstract

Update on applied epidural anatomy

Cited by 5 publications

References 21 publications

Long-term effects of neuraxial analgesia

Long-term effects of neuraxial analgesia

Epidural and Intrathecal Drug Delivery in Rats and Mice for Experimental Research: Fundamental Concepts, Techniques, Precaution, and Application

Physiology and Pharmacology of Epidurally Administered Drugs

Contact Info

Product

Resources

About