Talk:Epidural administration

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Untitled

I've heard a rumour that a tattoo on the lower back would prevent the giving of epidural infusion during child birth. Something to do with the fact of possible infections when the epidural needle passes through the tattoo (or near it).

Anyone have facts about this?

This article talks about "possible" neurological complications, but also says that no actual complications were found in the three cases they investigated: PMID 12477678. In a comment on that article, PMID 1470947, Krzysztof M. Kuczkowski, MD of San Diego says:

Douglas and Swenerton first reported on the administration of labour analgesia in three parturients with lumbar tattoos and discussed the possible ramifications of neuraxial analgesia in women with tattoos in the lumbar area.1 All three women received uneventful epidural analgesia, and no anesthesia-related complications were reported. I herein present a similar case, and the first report of a minor anesthesia complication resulting from epidural needle insertion through tattoos during the performance of neuraxial block. A 34-yr-old, healthy female at term was in labour and requested labour analgesia. Preanesthetic back examination revealed the colourful tattoos covering her entire lumbar area. An epidural block was performed in a standard manner (one attempt at L2–3 interspace) with an 18-gauge Tuohy needle. Several hours after an uneventful delivery, the patient reported tenderness and burning in the lumbar area where the epidural catheter had been sited. Examination revealed a localized L2–3 interspace tenderness, however, due to the presence of a tattoo in this area, skin redness (irritation) could not be determined. The neurological examination was normal and her symptoms resolved over the next 24 hr. A pigment-containing tissue core from a tattoo seems a possible cause of deeper lumbar tissue irritation.

So it's clear that there's not a lot of research on this. My inclination would be that this is the sort of thing anesthesiologists are trained to make professional judgments about, and the amount of research is thin enough that any comment by us one way or another on it is probably not worth it (by which I mean that we will more likely be confusing the reader than enlightening them.) I won't oppose a completely neutral cite to this or other research if someone else thinks this is an important addition to the article, but if I was deciding entirely on my own I'd probably just leave it out. Hope that helps, Nandesuka 13:00, 29 July 2005 (UTC)

In the "Side Effects" section it starts referring to childbirth, but nowhere before this in the article does it refer to childbirth. This is somewhat confusing. It actually refers to "fetal malpositions" which is even more confusing without referring in some way more specifically to childbirth. Dawhitfield 22:30, 9 August 2005 (UTC)

Snopes has a good summary of the tattoo/epidural issue here. (In general, Canadian doctors are more concerned than American ones.) --Arcadian 22:35, 4 March 2006 (UTC)

Epidural injection for chronic pain

Can someone who knows anything about this put together a comprehensive (or at least coherent) section on it?

Since over 50 years ago it was discovered that steroids injected epidurally can alleviate spinal pain as well as limb pain. The exact mechanism is not fully understood but it is presumed to be due to a decrese in inflammation. Epidural steroid injection are, likewise in labor and delivery, for chronic pain injected in the epidural space.

Facet Injection vs. Epidural Injection

Can anybody clarify the differences between a facet injection and a lumbar injection? Are they synonymous?

No. Vertebrae are held together by two kinds of joint. The main (load-bearing) joint is the rubbery intervertebral disc. However, there are also smaller synovial joints, called facet joints which link each vertebrae together. In certain diseases facet joints may become inflamed or painful, and injection of painkillers or anti-inflammatory medication into the synovial cavity of the facet joints may be performed. This treatment is designed to reduce pain and inflammation in one single facet joint only, and must be repeated for each involved joint (each vertebra has two). It is extremely fiddly, and not always possible, and doesn't always relieve pain.

For other types of back pain, an injection of anti-inflammatory medication (e.g. steroids) and painkillers may be performed into the epidural space (see main article). The types of pain treated and the types of injection performed are different in each case.

Preacherdoc 00:02, 1 June 2006 (UTC)Preacherdoc

For clarification- lumbar is the location of the body and facet is the part of the joint on the lumbar where the medication is given. For example, we have two choices to perform a series of three injections , in someone’s cervical area or in someones lumbar area. We then have a choice, depending on if there is radiculopathy present to perform a SNRB or Facet epidual injection. No Radiculopathy present, the patient’s back hurts more than the neck, so we will first perform a series of three Lumbar Facet eipdural injections. Hope this helps. Joanne1212 (talk) 01:57, 19 December 2017 (UTC)

General Indications

Epidural anaesthetics are being increasingly used for hip replacement surgery, yet this page refers almost exclusively to their use in parturition; it would be helpful if indications were more generally discussed. MikeSy 17:58, 1 June 2006 (UTC)

Not quite "almost exclusively", but I agree; when I get a bit of time I will expand. Preacherdoc 09:29, 4 June 2006 (UTC)Preacherdoc.

Right! That's better. Unfortunately Wikipedia logged me off mid-edit, and the new version is anonymous. However, the "moderate rewrite" was done by me. I aimed to remove the bias towards childbirth, and generally tidy up what had become quite a scrappy article.Preacherdoc 18:16, 15 July 2006 (UTC)Preacherdoc

Link

I added the following link to the article, but it was reverted without an explanation by User:Nandesuka. I think it's an excellent edition to the article and adds a different experience.

• Wendy Bellissimo: Willow's birth - The designer's story of her epidural during the birth of her third child

70.53.2.189 17:18, 24 July 2006 (UTC)

Since there doesn't seem to be a problem or objection with this link, I re-added it. (This is the same person as above, with a different IP) 67.68.138.190 01:31, 27 July 2006 (UTC)

Under the section "Epidural analgesia in childbirth" it mentions a study done in part by the University of Ontario in 2002. The link goes to the University of Ontario Institute of Technology which I know is incorrect. I attend UOIT and we have definitely never done a study on childbirth.....in fact, we had no students in 2002. The university is the newest in Canada and only began admitting undergrads in September 2003. It just started a graduate program in September 2006. Perhaps this is meant to be the University of Western Ontario? Cordova94 13:13, 26 October 2006 (UTC)

Monstrous Procedure

When my leg was operated with a spinal anesthesia, I was told by anethesiologist that he gives me 2 "shots".

• the first shot was pianful,
• the second one was just a pressure, following by

complete shutdown of the legs.

Could you please, deterimine which part of this writing is pertaining to a first shot, and second shot.

You will firnd yourself how to wikify, and format a clean distinction between 2 shots. THANKS

Since I don't know what your anesthesiologist did, I cannot explain what he did. He might have performed a standard epidural injection, for which the "first shot" would refer to a infiltrative injection of a local anesthetic (probably lidocaine) to initially numb the area followed by a "second shot," referring to the large-bore needle used to insert the epidural catheter.

If your anesthesiologist performed a spinal block injection in conjuction with the epidural catheterization, the "first shot" above was probably not mentioned, and rather referred to the spinal injection. This second explanation doesn't exactly fit well, because both the spinal and epidural procesures are performed with one stick of a needle, and so the epidural catherization wouldn't really be characterized as a "second" shot. However, if you claim that the second shot was followed immediately (word and emphasis inserted by me) by leg motor and sensory shutdown, it is highly unlikely, nay, almost impossible for you to have received a standard epidural without a spinal component, because epidural placement of local anesthetics do take about 15 minutes to kick in. Then again, you didn't say immediately (I did), and if you didn't intend to suggest it, perhaps I am speculating that you meant it. DRosenbach ^{(Talk | Contribs)} 00:23, 11 January 2008 (UTC)

I need to point out that Wikipedia is not the place to ask or reply to personal questions of a medical nature like this one. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

Saddle Block?

Is there such a thing as "Saddle Block"? Is this a common or slang term for "Caudal Anesthesia"? I have heard this mentioned as though it's an "alternative" to an "epidural"... can someone shed some light on this? If so perhaps there is value in adding it to the page. —Preceding unsigned comment added by 70.241.106.73 (talk) 09:31, 27 December 2007 (UTC)

A saddle block is a special case of a subarachnoid (spinal) anesthetic. A caudal block is a special case of an epidural anesthetic. There is some overlap in their uses, but the deposition of drug is anatomically distinct in the two approaches. —Preceding unsigned comment added by Dkazdan (talk • contribs) 03:01, 6 February 2008 (UTC)

History section is not neutral

The History section is very informative. However by stating that the development of the epidural procedure led to "a safe and painless method of childbirth" it makes the false assumption that previously all births were (a) unsafe and (b) always painful. See Ina_May_Gaskin and related links for more background. —Preceding unsigned comment added by 121.44.91.233 (talk) 12:35, 4 January 2008 (UTC)

Article requires general copy-edit

This article is poorly written, or at least contains sections that are poorly written, thereby reflecting poorly on the entire article and calling its authority into serious question. Drug names are misspelled (i.e. ropivicaine vs. ropivacaine) -- who is writing this, if not someone familiar with anesthesiology?

The section detailing the steps of an epidural catheterization included, prior to my minor editing, false information regarding both the physiologic entities traversed during catheterization, as well as misleading and confusing information regarding landmark/suggestive incidents that help the anesthesiologist perform the epidural catheterization.

Specifically, the "pop" occurs when an anesthesiologist pierces the dura (and the arachnoid), proceeding into the CSF-filled cavity known as the subarachnoid space with the much smaller gauge spinal needle, rather than accidentally proceeding too far with a Tuohy needle during an epidural. The pop is certainly not associated with piercing of the ligamenta flavum. My textbook (Basics of Anesthesia, Stoelting) makes no mention of "popping" when a Tuohy is advanced too far, but maybe yours does. DRosenbach ^{(Talk | Contribs)} 00:49, 11 January 2008 (UTC)

Well, you're about half right. Actually the flavum has an embryological midline defect. This means that if you are absolutely in the midline, you don't notice the pop as you go through it. However, the flavum is made of much denser tissue even than the interspinous ligament, and there is commonly both a noticeable increase in resistance as you traverse it, and a palpable pop when you breach it.

There is also a pop when you puncture the dura, with either a Tuohy needle or a pencil-point spinal needle.

Having rewritten the article considerably, I now hope you are more satisfied with it. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

Unhelpful diagram

Somebody has gone to a great deal of time and trouble to create a diagram, "Epiduraldiagram.png", which is wrong in many fundamental respects. For example, the pia mater is almost microscopically thin in life; here it is a thick layer. All of the spaces and structures are out of proportion. The epidural space is presented as an irregular space, when in fact it is quite regular in shape throughout. The bones as drawn here are reminiscent of vertebral bodies, although the part of the vertebra which should be here is the spinous process, whose shape is very different. The bones do not impinge on the epidural space the way they are shown. The ligamentum flavum (a lot bigger and more important than the pia!) is absent. As a means of illustrating the relationship of the epidural space to surrounding structures, this diagram, in my opinion, contains more that is wrong than right. Preacherdoc (talk) 16:59, 17 April 2008 (UTC)

There's lots of talk about layers and locations in the basic description of the procedure. This is extremely confusing to me. There is a diagram, but it's entirely useless as it lacks labels, and apparently it's inaccurate as well? Poor show. 94.193.253.59 (talk) 21:36, 31 August 2011 (UTC)

Requested move

The following discussion is an archived discussion of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the proposal was no consensus on move, let alone location to move to. JPG-GR (talk) 00:27, 15 May 2008 (UTC)

Epidural → Epidural analgesia — That's what the article is about. Epidural per se is an adjective that may refer to a number of things and should be changed to a disambiguation page. We should avoid jargon in titles. —Eleassar ^{my talk} 13:14, 6 May 2008 (UTC)

Survey

Feel free to state your position on the renaming proposal by beginning a new line in this section with *'''Support''' or *'''Oppose''', then sign your comment with ~~~~. Since polling is not a substitute for discussion, please explain your reasons, taking into account Wikipedia's naming conventions.

• Oppose the name change as suggested, because there are no alternatives to "Epidural analgesia". The name "Epidural" is not a good name for this page as per nom. However, "Epidural anesthesia" or "Epidural anesthetic" are better names than "Epidural analgesia", as the first line of the page suggests. Snowman (talk) 21:33, 8 May 2008 (UTC)
  • "Regional anaesthesia" is a good inclusive name for the page (and merge with the existing Regional anaesthesia page. Snowman (talk) 11:55, 10 May 2008 (UTC)
• Oppose Revise the article to include both analgesia and anesthesia. Also explain how an epidural differs from a spinal (if it already does, I didn't notice when I skimmed the article). --Una Smith (talk) 14:38, 9 May 2008 (UTC)

• Move to epidural anesthesia, which is a MeSH term.[1] Unsigned comment by Stevenfruitsmaak 16:50, 9 May 2008 (UTC)

Epidural analgesia is a MeSH term too[2]. There is also the following explanation: "The relief of pain without loss of consciousness through the introduction of an analgesic agent into the epidural space of the vertebral canal. It is differentiated from ANESTHESIA, EPIDURAL which refers to the state of insensitivity to sensation." Perhaps two articles would be needed although the advice by Ms. Smith is good too. --Eleassar ^{my talk} 17:20, 9 May 2008 (UTC)

• Move to epidural anesthesia (British vs. American spelling doesn't really matter) and explain the minor differences between anesthesia and analgesia in the article (the procedure is identical and the differences lie in indication, dose, and administration mode). "Epidural anesthesia" is the title under which most textbooks treat the procedure and by which nearly all professionals refer to it. "Epidural" is an adjective and its use to denote a procedure is slangish. We should not promote slang. Epidural could be made a disambiguation page. Kosebamse (talk) 06:41, 10 May 2008 (UTC)

  Addendum: second choice would be "epidural anesthesia/analgesia" or "epidural anesthesia and analgesia". Kosebamse (talk) 11:21, 10 May 2008 (UTC)

• Oppose. First, "Epidural" is the name by which this technique is most commonly known, even within the medical community (it is not "slang" but convenient shorthand). Second, there is enormous overlap between epidural analgesia and epidural anaesthesia: I do not think that it is helpful to separate them arbitrarily (One way around this is to rename a new article "Epidural Anaesthesia and Analgesia"). Thirdly, the only bit which (IMHO) needs to be split out of this article is the anatomy part, which should redirect to Epidural space. Fourthly, once this has happened, I don't know what one would want to put on a disambig page. I believe we would struggle to get more than about three entries. I don't care about MeSH terms: Wikipedia is not a medical textbook. What matters to me in an encyclopaedia is clarity and accessibility. Preacherdoc (talk) 10:50, 10 May 2008 (UTC)

• Re more than three entries: how about epidural space, epidural anesthesia and analgesia, epidural catheter, epidural cannula (okay, these two could be summarised under the anesthesia article, but not necessarily), epidural blood patch, epidural abscess, epidural hematoma, and that's only those that require not much thinking. Kosebamse (talk) 11:21, 10 May 2008 (UTC)

Thanks for your response. These are all already mentioned in an appropriate context in this article. A disambig page which just lists these titles would seem to be less helpful. Epidural anaesthesia and analgesia overlap so closely that any distinction is purely artificial and unhelpful. Epidural catheter and epidural cannula are the same thing and should certainly be in the same (unwritten) article as each other. Epidural haematoma has its own article, but Epidural abscess and Epidural blood patch do not (they each link to tangential articles). I just think, overall, that all this malarkey is solving a problem which doesn't exist; and the solution is likely to be less helpful than the status quo. Preacherdoc (talk) 15:22, 10 May 2008 (UTC)

• I understand that it is WP:Medicine's policy to use medical headings for clarity, so that we know what we are talking about. Snowman (talk) 11:29, 10 May 2008 (UTC)

Agreed. However, if a "lay" person types "epidural" into Wikipedia, they get this article, which is almost certainly what they were looking for to begin with. Someone with more knowledge could type "epidural analgesia" and they would also end up here. I think changing this is unhelpful and unnecessary. Finally, "epidural" is a perfectly acceptable medical word. Preacherdoc (talk) 15:22, 10 May 2008 (UTC)

What is your definition of "Epidural"? I think that the problem is that "Epidural" could have different meanings depending on context. There are several suggestions about what this page could be. It probably could be a dab page to include listing "Epidural space". Snowman (talk) 18:35, 10 May 2008 (UTC)

I suppose you are asking about definition in order to nail me down to saying that the word "epidural" is an adjective, and therefore shouldn't be in title in and of itself. However, in common usage (including the medical community), the word "epidural" is used as a noun, and I (still) think the great majority of users who are looking for information about "epidural anything" would start with this title. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

But, epidural is not the official name for anything. Your suggestion is not in line with Wikipedia:Manual of Style (medicine-related articles). The article title should be the scientific or recognised medical name rather than the lay term. There could be almost no end to page names using short unofficial (and confusing) names. Snowman (talk) 22:17, 10 May 2008 (UTC)

We are starting to go in circles a little here. The current title, IMHO, is neither incorrect, nor confusing. Preacherdoc (talk) 11:02, 11 May 2008 (UTC)

• Oppose The current title is fine. --Bookworm857158367 (talk) 14:03, 12 May 2008 (UTC)
• Support move. While the abbreviation is in very common use (especially in obstetric context), it remains an abbreviation. Support replacement of this page by a disambig. JFW | T@lk 19:39, 12 May 2008 (UTC)

Discussion

Any additional comments:

Epidural anaesthetic is another possible good name for the page, but it has an English and an US spelling. Snowman (talk) 21:30, 8 May 2008 (UTC)

I don't quite agree here. While anesthesia refers to a complete loss of feeling, analgesia refers only to insensibility to pain (per OED) and that's how and what it is primarily used for. In addition, for some anesthetists anaesthesia implies loss of consciousness which is not the case here. --Eleassar ^{my talk} 09:13, 9 May 2008 (UTC)

But an epidural anesthetic does cause complete loss of feeling in the region affected (usually lower half of the body). It is similar to a local anesthetic. I do not agree with your view about anesthetists jargon as used in the English language. The name of the page should be "Epidural anesthetic" (or perhaps "Epidural anesthesia"). Snowman (talk) 10:25, 9 May 2008 (UTC)

The English spelling, "anaesthetic", can be covered with redirects. Snowman (talk) 10:50, 9 May 2008 (UTC)

Surely an epidural anesthetic can cause complete loss of feeling in the dosage large enough but it's primarily used to relieve pain. How could e.g. a puerpera actively participate in the labour if she would not feel anything? Even the article itself says: "a good epidural can provide analgesia without affecting muscle power or other types of sensation. The larger the dose used, the more likely it is that the side-effects will be problematic." As for the jargon, it was sourced from [3] --Eleassar ^{my talk} 11:23, 9 May 2008 (UTC)

Some caesarian sections are done under epidural anaesthesia. This website uses epidural anaesthesia. I am sure that there are others use epidural analgesia. Women in labour can participate, because consciousness is retained with an epidural. Snowman (talk) 11:48, 9 May 2008 (UTC)

If that's so, then explain this: "The goal of an epidural is to provide analgesia, or pain relief, rather than complete anesthesia, which is total lack of feeling." Also explain why is it necessary to supplement opioids in the second stage of labor so that the dosage of levobupivacaine or other anesthetic may be reduced if it's only about retaining consciousness. In any case, even if anesthesia is achieved it's primarily about blocking pain, not other sensations - so the article should be titled 'epidural analgesia' and should state that sometimes full sensory block (anesthesia) is necessary. --Eleassar ^{my talk} 12:16, 9 May 2008 (UTC)

I think that the website that you linked above does not seem to support you. It says "Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body." It also extensively uses the term "epidural anaestheia", and therefore does not support your suggested name name. This website is about the use of "epidural anaestheia" for Caesarian Section. Snowman (talk) 12:50, 9 May 2008 (UTC)

That's taking sentences out of their context. No one denied that epidurals decrease sensation (especially pain). I also don't know how can the prevalent usage on this single web page determine what is correct. It's the definition that counts. There are plenty of expert articles that use the term epidural analgesia. Could you please answer my questions now? --Eleassar ^{my talk} 17:25, 9 May 2008 (UTC)

By G-hits "epidural anesthesia" is more frequent than "epidural analgesia", and that is not including hits for the UK English spelling of "epidural anaesthesia". I think I have explained enough. Snowman (talk) 20:35, 9 May 2008 (UTC)

Analgesia and anesthesia are not synonyms. --Una Smith (talk) 20:38, 9 May 2008 (UTC)

I think that is correct, they are not synonyms. Analgesia (partial anaesthesia here probably) or anaesthesia may both be produced by an epidural anesthetic. I think that the nerve block could not possibly be so selective to affect only pain fibres, because the stabilizing effect of the local anaestheic drugs will non-specifically affect all nerve membranes, especially as the dosage increases. Snowman (talk) 21:01, 9 May 2008 (UTC)

Snowmanradio, is your argument that "epidural anesthesia" and "epidural analgesia" are synonyms? --Una Smith (talk) 21:07, 9 May 2008 (UTC)

That is a good question? I am thinking that there is a spectrum. What is the answer? Snowman (talk) 21:36, 9 May 2008 (UTC)

Hope this explains. I put an epidural in a patient and give a small amount of anaesthetic. The patient gets analgesia (pain relief), but not anaesthesia (other sensations preserved). Then I give a large amount of anaesthetic. The patient now has anaesthesia (all sensations lost). There is indeed a spectrum. The insertion is identical; all that changes is the dose and the effect. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

I doubt if it is as selective as that. I would expect from the mechanism of a local anesthetic agent that some sensation is lost and some pain is retained with lower doses owing to partial blocking of both pain and sensation. As the dose increases the effect to block more and more nerves becomes more complete. I understand that a little opioid may be given to augment the analgesia of low dose regional anesthesia. Snowman (talk) 16:27, 11 May 2008 (UTC)

This is purely your own understanding. --Eleassar ^{my talk} 11:24, 12 May 2008 (UTC)

Actually it is as selective as that. There are several types of nerve fibre which perform different types of function. 90% of pain transmission is carried in type-C fibres, which are un-myelinated and therefore are more susceptible to the effects of local anaesthetic (LA) drugs. (Temperature sensation and sympathetic nervous system function is also carried by non-myelinated fibres). Motor power, touch, vibration and proprioception are mostly carried in type-A fibres, which are larger, myelinated, and are more resistant to LA drugs. This means at a low dose of LA, you take out the type C fibres and spare the A fibres. At a very high dose, you take out everything. WP has surprisingly little about this currently. Preacherdoc (talk) 14:49, 12 May 2008 (UTC)

In the US many pregnant women seem to obsess endlessly over whether to get an epidural or not, or how to ensure they get it the moment they want it, yet only a minority are aware of epidural vs spinal and anesthesia vs analgesia. So, because all these options involve a common mode of administration and can be chosen among or combined, I would recommend keeping them together in one article. --Una Smith (talk) 20:38, 9 May 2008 (UTC)

And what would you suggest is the name of that article? The article briefly includes epidurals for caesarian section. It does not include use of epidural anesthetics for inguinal hernia operation (I am not sure if they are still done this way). Snowman (talk) 21:01, 9 May 2008 (UTC)

My oppose above means I think the current title should remain. --Una Smith (talk) 21:07, 9 May 2008 (UTC)

It would be unusual to perform hernia repair under epidural anaesthesia, although quite feasible. General or spinal anaesthesia would be vastly more common. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

And what is the definition of the current title, "epidural"? Snowman (talk) 21:36, 9 May 2008 (UTC) There is already a page, Regional anesthesia. Snowman (talk) 22:48, 9 May 2008 (UTC)

The title is fine; the content needs work. --Una Smith (talk) 14:16, 10 May 2008 (UTC)

Outside opinion

• I came here after seeing Preacherdoc's post on WP:MED. For those with any concern, I think he did a good job of covering both sides of the disagreement here. I thought I'd make the following suggestion to see if you all would find it helpful:

  Consider using the see also template at the top of this page to redirect to other epidural topics. An (off-topic) example immediately follows my post. Antelan^talk 17:07, 12 May 2008 (UTC)

See also: Cat, Lol, and Lolcat

Thanks, Antelan. This could work. I've taken the liberty of trying it out with the article. Preacherdoc (talk) 14:02, 13 May 2008 (UTC)

The above discussion is preserved as an archive of the proposal. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Related stubs

Related stubs that may merit being merged into this article. Note that they conflate analgesia and anesthesia. --Una Smith (talk) 14:16, 10 May 2008 (UTC)

• Combined spinal and epidural anaesthesia
• Spinal analgesia

I am thinking Epidural should be a disambig, linking to Epidural space and Epidural (technique), among others. Epidural (technique) would contain most of the content of the current Epidural. That may help to encourage linking text that conveys more precise meanings, like this: ... [[Epidural (technique)|epidural]] [[analgesia]].... --Una Smith (talk) 14:16, 10 May 2008 (UTC)

I really, really, really don't think we should arbitrarily separate epidural analgesia from epidural anaesthesia. This is not "conveying more precise meanings", but trying to artificially separate two things which overlap considerably. I can just about accept the case for making "Epidural" a disambig page with links to other topics, but I think (as above) that this makes the article "Epidural" less useful, since all the other topics associated with epidural are covered, appropriately, within the existing article. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

I am not suggesting epidural analgesia and epidural anesthetic be separate articles; I think those topics belong together in one article. --Una Smith (talk) 01:46, 11 May 2008 (UTC)

Sorry, Una Smith. I misinterpreted your previous remark. Preacherdoc (talk) 11:02, 11 May 2008 (UTC)

Bit of a rewrite

I've done a bit of a rewrite this evening. This article is (IMHO) much better laid out and contains many more references (there are loads still to add but I am starting to see double). Much of the criticism above has been addressed (I hope).

The article is now pretty long and probably needs to be split rather than merged with anything. You could always merge Combined spinal and epidural anaesthesia with Spinal analgesia. Both are pretty weak articles as they stand and could use a little propping up. That said, I would oppose that merge, since they are technically quite distinct techniques.

I still think (see my comments above) that the anatomy section of this article is completely worthless; I haven't even touched it.

I also think that there is a lot about epidurals in childbirth (including a pretty long discussion of potential harms and benefits) which could profitably be split out to a new article (e.g. Epidural analgesia in childbirth) or similar.

Finally, the History section was pretty windy and full of POV; I have tried to condense it down, but it really isn't all that great (nor, perhaps, relevant). It belongs in the non-existent History of regional anaesthesia article. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

Effects on the Baby

The "Effects on the Baby" section looks pretty shoddy. Broken footnotes, phrase like "a noticable lack" and things like that. It looks like someone tried to edit it with a chainsaw and crayons. 24.155.174.23 (talk) 23:22, 24 April 2011 (UTC)

Bolus or infusion?

To be brought up to wikipedia's quality standards would anyone else be in favor of changing the title of the subsection known as Bolus or infusion? ... the question mark appears unprofessional. I think it warrants a different title. Briwivell (talk) 00:30, 29 February 2012 (UTC)

There was a med error in the hospital. A young woman had an epidural for pain control post surgery and a bag of heparin was accidentally hung at 8u/hr. Her hptt was normal after getting 34 hrs of medicine injected and her INR was 1.6. She did not develop a hematoma but did display pain and it was not found during those times but until the bag ran out. — Preceding unsigned comment added by 67.172.14.90 (talk) 13:32, 31 March 2012 (UTC)

Reverted edits from 9-16-12

I reverted the removal of potential risks. The reliable reference included (Cochrane) does list these as risks. jsfouche ☽☾Talk 23:01, 16 September 2012 (UTC)

Horrible intro

This is the kind of article that gives Wikipedia a bad name. Instead of saying what epidural is, it talks all around it in the introduction. Tehcnical stuff is fine -- but first just tell the reader what the subject is. 211.225.33.104 (talk) 06:26, 5 September 2013 (UTC)

Why does "peridural" redirect here?

Term not explained in article. 109.157.79.50 (talk) 23:54, 3 February 2015 (UTC)

Controversial claims ("Complications" section)

This subsection(?) appears to have been haphazardly tacked on to the "Complications" section, it contradicts claims made earlier in the article, and it has generally poor spelling, clarity, and organization.

The first bullet point seems to indicate that "epidural anaesthesia and analgesia significantly slows the second stage of labour" is a controversial claim; however, "Longer delivery (second stage of labour)" was listed in the Advantages/Disadvantages chart (derived from a Cochrane review of studies relating to using epidurals for childbirth) in the "Epidural analgesia during childbirth" section earlier in the article. It may be that the hypotheses for why this is the case - rather than whether it is the case - are controversial, but this distinction is not clearly indicated.

The wording of the second main bullet point (regarding the effects of the reclined position of the woman) is vague enough that I am not at all certain of what it's trying to communicate. Perhaps that it is plausible that the woman assuming a reclined position could have an effect on the fetus? If so, what effect is being discussed? Also, while I'm not a seasoned Wikipedia editor, "plausible" doesn't seem like a word that should be used; the definition is far too imprecise.

The third main bullet point (regarding the rate of Caesarean sections after epidural analgesia administration) cites the Cochrane review mentioned earlier in this article to argue that women undergoing epidural analgesia during childbirth do not have a significantly higher rate of Caesarean-section delivery compared with those who do not undergo epidural analgesia. Unlike the following paragraph, this statement fails to acknowledge that said review is comprised primarily (33 out of 38) of studies that only compare Caesarean rates between childbirths involving epidural analgesia and childbirths involving opiates as non-epidural analgesia; furthermore, the abstract does not distinguish its comparisons of epidural analgesia vs non-epidural analgesia from its comparisons of epidural analgesia vs no analgesia. Based on this, it seems wiser not to make a sweeping statement.

Should this section be removed entirely or rewritten? As mentioned above, I am no Wikipedia veteran, so I didn't want to commit an editing faux pas. TheRollingMan (talk) 20:46, 9 June 2015 (UTC)

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WikiProject Medicine Enhancements

Hello,

I am a fourth year medical student, and I am hoping to improve the content on this Wikipedia page in the coming weeks. I hope to address the following in my updates to the page:

1) I would like to provide better organization of headers more closely following WikiProject guidelines: Difference from spinal anesthesia Indications Contraindications Side effects Complications Anatomy Technique (avoid step-by-step instructions) Special situations History (e.g., when it was invented) 2) I would like to add a section on contraindications, as indications are mentioned without the contraindications. 3) I hope to find additional sources for the anatomy section in order to prove its value. 4) In the later half of the technique section, I would like to expand the subheadings to distinguish how and why you choose certain techniques and options. 5) I would like to find sources to confirm information written in the "side effects" section. Additionally, this section could benefit from organizational and formatting changes. 6) I hope to expand the "history" section depending on the depth of information that is available as to include more dates and significant activities.

I am excited to begin making these changes and updating the content on this page to better describe the topic. Please let me know if you have any advice or corrections that you believe should be made to either my plan or the original Wikipedia page.

Thanks for the help, Cwwweeden (talk) 03:11, 25 October 2018 (UTC)

Excellent job on providing some more organization and adding content to this article. In response to some of your changes:

-The contraindications section is well organized, concise and provides a good overview.

-The anatomy section is well written and does a good job of giving a simple explanation of the relevant anatomy. If you can find a picture or diagram of this to help readers get a better visualization of the epidural space.

-Great job on expanding on this "technique" section and citing appropriate sources

-The side "effects" section flows well and is easy to read. Good job on providing sources for all of your content

Kz0190 (talk) 21:34, 14 November 2018 (UTC)

Uncited content

I'm removing the following content for being uncited as of now, but will try to reincorporate it if I can find sources - please feel free to add sources here and/or readd it into the article with sources:

Removed content

Caudal approach The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane. Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality. Combined spinal-epidural techniques Main article: Combined spinal and epidural anaesthesia For some procedures, the anaesthetist may choose to combine the rapid onset and reliable, dense block of a spinal anaesthetic with the post-operative analgesic effects of an epidural. This is called combined spinal and epidural anaesthesia (CSE). The practitioner may insert the spinal anaesthetic at one level, and the epidural at an adjacent level. Alternatively, after locating the epidural space with the Tuohy needle, a spinal needle may be inserted through the Tuohy needle into the subarachnoid space. The spinal dose is then given, the spinal needle withdrawn, and the epidural catheter inserted as normal. This method, known as the "needle-through-needle" technique, may be associated with a slightly higher risk of placing the catheter into the subarachnoid space.Indications and contraindications Injecting medication into the epidural space is primarily performed for analgesia. This may be performed using a number of different techniques and for a variety of reasons. Additionally, some of the side-effects of epidural analgesia may be beneficial in some circumstances (e.g., vasodilation may be beneficial if the subject has peripheral vascular disease). When a catheter is placed into the epidural space (see below) a continuous infusion can be maintained for several days, if needed. Epidural analgesia may be used: For analgesia alone, where surgery is not contemplated. An epidural injection or infusion for pain relief (e.g. in childbirth) is less likely to cause loss of muscle power, but can subsequently be conveniently augmented to be sufficient for surgery, if needed. As an adjunct to general anaesthesia. The anaesthetist may use epidural analgesia in addition to general anaesthesia. This may reduce the patient's requirement for opioid analgesics. This is suitable for a wide variety of surgery, for example gynaecological surgery (e.g. hysterectomy), orthopaedic surgery (e.g. hip replacement), general surgery (e.g. laparotomy) and vascular surgery (e.g. open aortic aneurysm repair). As a sole technique for surgical anaesthesia. Some operations, most frequently Caesarean section, may be performed using an epidural anaesthetic as the sole technique. This can allow the patient to remain awake during the operation. The dose required for anaesthesia is much higher than that required for analgesia. For post-operative analgesia, whether the epidural was employed as the sole anaesthetic, or in conjunction with general anaesthesia, during the operation. Analgesics are administered into the epidural space typically for a few days after surgery, provided a catheter has been inserted. Through the use of a patient-controlled epidural analgesia (PCEA) infusion pump, a patient can supplement an epidural infusion with occasional supplemental doses of the infused medication through the epidural catheter. For the treatment of back pain. Injection of analgesics and steroids into the epidural space may improve some forms of back pain. See below. For the treatment of chronic pain or palliation of symptoms in terminal care, usually in the short- or medium-term.

Thanks, -bɜ:ʳkənhɪmez (User/say hi!) 06:30, 12 September 2020 (UTC)

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

This review is transcluded from Talk:Epidural administration/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Bibeyjj (talk · contribs) 11:35, 29 November 2020 (UTC)

Hi Berchanhimez! I'm happy to take up the review for this article. Just from a general glance, it looks really good. I will try to complete this review in the next few days. Thanks! Bibeyjj (talk) 11:35, 29 November 2020 (UTC)

GA review (see here for what the criteria are, and here for what they are not)
It is reasonably well written. a (prose, spelling, and grammar): b (MoS for lead, layout, word choice, fiction, and lists): It is factually accurate and verifiable. a (references): b (citations to reliable sources): c (OR): d (copyvio and plagiarism): It is broad in its coverage. a (major aspects): b (focused): It follows the neutral point of view policy. Fair representation without bias: It is stable. No edit wars, etc.: It is illustrated by images, where possible and appropriate. a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):
Overall: Pass/Fail:
· · ·

Summary

Overall, this article is very good, with a good written style, good references, useful content, a neutral tone, edit stability, and helpful graphics. Given that most good medical procedure articles mention recovery (and this is part of the Medical Style Guide for procedures), I personally think that a dedicated section on recovery (duration, variations etc.) would be helpful. This is a minor change, and all its needs is a few sentences to outline it - some content on recovery times is already included in the article, just in other places. I certainly hope that these changes can be made soon. For now I have put the nomination on hold pending this minor change. Thanks! Bibeyjj (talk) 14:41, 29 November 2020 (UTC)

Comments

Criterion 1

1a. Pass. Very good style of writing, which gives the right amount of detail for readers. Sentences are readable, with good grammar. Bibeyjj (talk) 12:00, 29 November 2020 (UTC)

1b. Pass. Excellently follows the WikiProject Medicine style guide for procedures. Follows generally agreed principles on organisation and syntax, including for headings. Bibeyjj (talk) 12:00, 29 November 2020 (UTC)

Criterion 2

2a. Pass. Inline citations used correctly and fairly generously. A good number of references based on the amount of content. Bibeyjj (talk) 12:44, 29 November 2020 (UTC)

2b. Pass. Although everything is well sourced from scholarship, and all sources are reliable, I do feel that there is a slight overdependence on primary rather than secondary sources. This is only minor, but typically secondary sources are preferred for their more consensus-based ideas. Bibeyjj (talk) 12:44, 29 November 2020 (UTC)

2c. Pass. Nearly all content is well covered by inline citations, and is well researched from scholarship. There are a few places that could do with coverage by an inline citation, such as the various complications of bipuvacaine in "Medication-specific", and bolus content in "Use and removal", but these are minor issues for future referencing. Bibeyjj (talk) 12:44, 29 November 2020 (UTC)

2d. Pass. Content is well covered by inline citations, and so there can be no major copyright violations. Having checked a number of the sources, it is clear that referenced content is represented fairly and cited properly. Bibeyjj (talk) 12:44, 29 November 2020 (UTC)

Criterion 3

3a. Fail. The content already provided deals with the most important aspects of the topic. I feel that a dedicated section on recovery would be useful, as some content is either absent or spread over the whole article. For example, the recovery time is stated as "only a few minutes or up to several hours" in "Risks and complications". More practical advice on recovery is relevant to the article as a whole, and is the main missing section. I'm sure that it will not take long to find relevant content (such as this from the NHS website). Bibeyjj (talk) 14:26, 29 November 2020 (UTC)

3a. Pass. The relevant suggestions on adding a recovery section have been followed (in accordance with the layout suggested by the Medicine Style Guide), and some really excellent well-referenced content has been moved from elsewhere and new content added. Bibeyjj (talk) 09:14, 2 December 2020 (UTC)

3b. Pass. All content is relevant to the subject, and links back well. There is enough technical detail for a good understanding of the procedure. Bibeyjj (talk) 14:26, 29 November 2020 (UTC)

Criterion 4

4. Pass. All the content is neutral in tone. I appreciate the progress that has been made on this issue considering some of the more biased content that used to be included in the article. Particularly the "History" and "Society and culture" sections present evidence-based information in a good way. Bibeyjj (talk) 14:28, 29 November 2020 (UTC)

Criterion 5

5. Pass. No edit wars or ongoing content disputes. The past content disputes have all been resolved. Bibeyjj (talk) 14:30, 29 November 2020 (UTC)

Criterion 6

6a. Pass. All media are formatted, with copyright statuses noted. Bibeyjj (talk) 14:37, 29 November 2020 (UTC)

6b. Pass. All graphics relevant, with useful captions to demonstrate written content clearly. I appreciate that available content has been used, and I certainly hope that more images will become available in the future for the "Risks and complications" section - obviously, the current images are excellent. Bibeyjj (talk) 14:37, 29 November 2020 (UTC)

References

References

Follow-Up Comments

User:Bibeyjj: I've added a recovery section by moving some of the information into it from another section, as well as adding some more information I found. If you could take another look and offer any further comments you may have on the whole article (even if they won't fail it at this time, I appreciate and will work on any other issues you find as well) I'd appreciate it! Thanks, -bɜ:ʳkənhɪmez (User/say hi!) 05:26, 2 December 2020 (UTC)

Hi Berchanhimez! Thank you for your recent edits, which have made a real improvement to the content and structure of the article. I am now prepared to pass the article. Congratulations! Bibeyjj (talk) 09:14, 2 December 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

"Loss of resistance technique" redirect

"Loss of Resistance" redirects to this Epidural administration page, I believe incorrectly (or at least misleadingly) as "loss of resistance technique" is not specific to epidurals.

As an example of the incorrect redirect, I arrived at this page by following the "loss of resistance technique" link on the Fascia iliaca block page.

The only description of the technique in this article is in the Epidural administration#Insertion section: "Along with a sudden loss of resistance to pressure on the plunger of the syringe, a slight clicking sensation may be felt by the operator as the tip of the needle breaches the ligamentum flavum and enters the epidural space." Information which is very specific to epidurals.

I think "loss of resistance technique" should have its own page, but I am not remotely qualified to do this. Is there someone who is who could step in? Paxman (talk) 00:12, 6 April 2023 (UTC)