As a part of my Anesthesiology residency, tomorrow is going to be my first attempt at Epidural block. I came here to review the method. Thanks for the wonderful video.
I agree Terry! It’s an amazingly simple, yet effective, way to determine the entry of the needle into the epidural space, and in spite of the availability of bedside imaging techniques like ultrasound to aid in needle insertion, it’s almost never used because the plunger resistance technique is so accurate...
@@TrialImageIncUltrasound isn't used because the acoustic window is very poor, and even if it wasn't it's not possibleto reliably see ligamentum flavum or the dura on B-mode. The reason ultrasound is not used is not because LOR technique is so good - it's because it doesn't work.
I remember looking back on my first when I had my 2nd & imagined it to be so much longer in my apparent dramatic ness. But honestly, even realistically looking at it, it's still long. I remember when they came out w/ that tray of tools & I was like 😦 ure gonna stick that thing in me? Wever, I guess it can't be any worse than bringing in this baby. I had 2 c sections. My 2nd had my tubes tied right after. But I was like I do not even want to watch. Granted I wouldn't have had the greatest view anyways. But I still closed my eyes
Hi, i was given an epidural at my daughter's birth and right after a few hours when i was 10 centimeters open i got a terrible pain arround my shoulders my neck and my head.. it was so severe that i couldn't lift my head at all.. my lover body was totally numb that i couldn't even move my legs or be able to sit. I went through this terrible pain along with nausea for 10 days.. never going to forget that horrible experience !!
Sheeri Zainab its normal in epidural but its may be drugs reaction becouse i seen that feeling in 30% female who cry and shout alot in spinal but some time some patients are lie alot even they dont feel any thing with out she feel some one tuch but she dont know pain are surgery
My pleasure Hafizah! Apologies for the very delayed response - I didn't realize RUclips was holding some of my comments for approval. You can view my entire medical video library at trialimage.com
If the first catheter placement results in intrathecal placement determined by the patient's inability to move their legs after a test dose of lidocaine or other local anesthetic, how would correct placement of the catheter be determined on the second attempt if the patient is unable to move their legs?
@@TrialImageIncspinal catheters themselves are useful tools. Would you remove the one you've just accidentally inserted? The AOA suggests leaving them in because of their utility and the reduction in PDPH compared to taking them straight out. You might be grateful for it if the patient later needs LSCS.
+Prachita Srivastava - the epidural space is filled with fatty tissue, and this fatty tissue resists the upward movement of the anesthetic agent. This resistance can be overcome by the dose and rate of medication infusion. Thus, a lower rate of infusion results in a lower level of medication movement in the epidural space, and a higher rate of infusion will result in the medication moving higher in the space. The level of the anesthetic can be determined by careful monitoring of limb sensation, and an anesthetic level that is too high may cause cardiovascular symptoms, nausea and agitation. I hope this helps... CalShipleyMD.com
Thanks for your comment roserry! The epidural anesthetic revolutionized pain control during labor without adverse effects on the fetus You can view my entire medical video library at trialimage.com/
Hi - there is no hard limit on how many needle insertions can be performed, but most authorities recommend no more than 2-4 per procedure. Once you have performed that many unsuccessful attempts, you really need to stop and re-evaluate the situation - is there an anatomical or physiological reason for the problem, or is the insertion technique of the operator at fault, and is there a less invasive method available for achieving anesthesia?
The reason for the epidural is to get rid of the pain. If the pain doesn't go away, they may have administered it wrong, or you may have an allergy to Lidocaine?
Is this the same one my pain doctor said I'd be getting injections in my back for pain I have,I have hernated discs and lumbar radiculopathy plus nerve damage in my right foot and leg,please help its injection for pain,anastetic without steroids as they failed 2wice the steroid injections so I'll be giving just the anastetic injection to help with back pain
A mi me hicieron cuatro hace trece años que no me sirvieron para nada, al final tuvieron que operarme, y ahora me veo que mañana me lo vuelven hacer por que aun operado se ha reproducido la hernia
Hi Marie - the consequences of an errant injection depend on specifically where and how much of the anesthetic is injected. Theoretically, a misplaced injection could cause serious problems, especially if the continuous drip affects the spinal cord in the area of the heart and lungs. Fortunately, incorrect placement of the anesthetic is rare owing to the test dose that is administered ( as seen in my animation)...trialimage.com
Hi Maritza - a misplaced injection can cause serious side effects, including respiratory arrest. Fortunately, this is very rare provided the test dose is performed as noted in the video...You can access my entire medical video library at: trialimage.com
Can this technique be an alternative to the general anesthesia in a patient with myelomeningocele L3-L4 not tolerating general anaesthesia? Is it possible that that type of anesthesia does not take effect in that case, causing the patient to feel the painful stimulation completely?
Meningoceles can certainly interfere with the spread of local. They are generally considered a contraindication to any neuraxial anaesthesia, not just epidural. Why would the patient not tolerate general anaesthesia?
@@joestevenson5568 it ends out in me strongly vomiting for at least 6-7 Times during the next 6 hours since waking up from the surgery. Not a good feeling.
I have sciatic pain severe I have never went through sciatic pain like I did the day before yesterday I was in the floor crying I couldn't even get out of the floor and I found out something that really helped me I even went to the hospital and the muscle relaxer they gave me in the more thing did not even help I'm going to be making a video telling what I did to help my sciatic pain and I will demonstrate it and show you what I take too so hopefully I can get this video record it and upload it after I feel a little bit better my leg and my calf is still numb and I still got pain in my back but it's not like it was the day before yesterday
Hi - only the sensory branches of nerves are anesthetized - no motor (muscular) branches. That's the reason for checking that the patient can move their legs after the test dose. You can access my entire library of medical videos at trialImage.com
I love epidural. Because I have a lot of pain while I getting labor my son.epidural looks magic for me because went they injeck me and put the needle of my back it takes me stickles I was laughting a lot .I'm such helrious I dint not feel the pain.two nurse hold my hand .and one doctor I try to turn my back how they put epidural on me because I was curious. I'm not a loud so I heard everything all my tick less in my back it came out men.its feels so good its just they put some raser bleed
is at possible to fly with an liquorcanal damage, liquorunderpressuere syndrom(not postpuncture) ? and is it possible to fly with this syndrom and a subdural hämatoma caused by liquorunderpressure?
Is it normal after 4hour or more receiving epidural anesthesia that you cant even move your leg....i've got an infection on my right thigh nerve,swelling and full of pus so the doctor need to discard it and suggest me to take an epidural anesthesia.....
Or, maybe not? Because it's a pretty.. small incision.. So, it should heal fast. Don't take my word on it, I am still trying to learn. And I am too young to be an MD.
My girl got thag when given birth now she can't stand her back she gets pain like no other after the whole birth thing ... :( all the time for her rest of her life she's going to have does back pains
+nepaliman - rate of continuous infusion varies according to the type and concentration of anesthetic medication used, and patient response. If you send me a message through the contact page of my website at CalShipleyMD.com, I can forward an excellent review of epidural anesthesia to you...cjs
do you maybe know what happend to my brother he almost die doing simple surgery of knee he had 10 days 40c temperature not be able to move his head even go to toilet then they take out more fluid from spine and he was better after few days .Thank you so much
I want more information about this treatment because I have patient at home .who had been got fractured at L5 and there is no movement from her waist to palm. Can anybody help me and me more information.
Eman sweileh we doing that with help of local anesthetic madicine first of all we injact small amount of local becouse of that patient dobt feel needale but some Doctors are dont useing they follow book
Its so amazing men.the dortor and nurses look at me I'm weard .the truth for real men.its the fault s give me tick less while they put epidural on my back OK.he makes me laught I cannot stop it
There is no spinal cord below L2. They avoid dural puncture by the loss of resistance technique. This is all explained very clearly in the video. Rewatch it.
![ARGENTINA vs. CHILE [3-0] | RESUMEN | ELIMINATORIAS SUDAMERICANAS | FECHA 7](http://i.ytimg.com/vi/De3AWmXzhuA/mqdefault.jpg)
As a part of my Anesthesiology residency, tomorrow is going to be my first attempt at Epidural block. I came here to review the method. Thanks for the wonderful video.
Hi Dr. Abe90 - how did it go?
It hurts youuu
how did it go?
"He was never heard from again."
Fantastic explanation and animation. We’re so lucky these days to have resources such as this.
Thank you Mike! You can access my entire library at www.CalShipleyMD.com
lotta respect to the doctors all around the world for what they do and to my dad who is also a doctor, its just wild to see this animation. Thank you.
This is the only video that didn't make me nervous. I feel much better about what will happen. Thank you
Glad it helped Ocean! You can access my entire library of medical videos at trialimage.com
The release of the plunger resistance to indicate that needle has been inserted the correct distance, is pure genius!
I agree Terry! It’s an amazingly simple, yet effective, way to determine the entry of the needle into the epidural space, and in spite of the availability of bedside imaging techniques like ultrasound to aid in needle insertion, it’s almost never used because the plunger resistance technique is so accurate...
@@TrialImageInc Excellent!
@@TrialImageIncUltrasound isn't used because the acoustic window is very poor, and even if it wasn't it's not possibleto reliably see ligamentum flavum or the dura on B-mode.
The reason ultrasound is not used is not because LOR technique is so good - it's because it doesn't work.
Just did spinal anesthesia three weeks ago. Did not know the needle was so long. I felt more nervous watching this than during the surgery 😂
I remember looking back on my first when I had my 2nd & imagined it to be so much longer in my apparent dramatic ness. But honestly, even realistically looking at it, it's still long. I remember when they came out w/ that tray of tools & I was like 😦 ure gonna stick that thing in me? Wever, I guess it can't be any worse than bringing in this baby. I had 2 c sections. My 2nd had my tubes tied right after. But I was like I do not even want to watch. Granted I wouldn't have had the greatest view anyways. But I still closed my eyes
Very clear explanation of procedure and following test for placement accuracy.
Thank you Glen. You can access my entire library of medical presentations at www.CalShipleyMD.com
Hi, i was given an epidural at my daughter's birth and right after a few hours when i was 10 centimeters open i got a terrible pain arround my shoulders my neck and my head.. it was so severe that i couldn't lift my head at all.. my lover body was totally numb that i couldn't even move my legs or be able to sit. I went through this terrible pain along with nausea for 10 days.. never going to forget that horrible experience !!
Sheeri Zainab its normal in epidural but its may be drugs reaction becouse i seen that feeling in 30% female who cry and shout alot in spinal but some time some patients are lie alot even they dont feel any thing with out she feel some one tuch but she dont know pain are surgery
Oh my god, thank you for that. Now it makes sense!
Wow that was a very good video! Loved how you got specific with everything!
Thanks Brian! You can access my entire library at www.CalShipleyMD.com
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 22/8/2018 😊
My pleasure Hafizah! Apologies for the very delayed response - I didn't realize RUclips was holding some of my comments for approval. You can view my entire medical video library at trialimage.com
Beautifully done and very concise. Thanks.
Thank you David! You can access my entire library of medical videos at trialimage.com
Wonderful video for learners like me. Thanks a lot Dr.
Glad it helped Zameer - You can access my entire library at www.CalShipleyMD.com
When I get older I want to be an OB/GYN. I already know quite a few things. :o
If the first catheter placement results in intrathecal placement determined by the patient's inability to move their legs after a test dose of lidocaine or other local anesthetic, how would correct placement of the catheter be determined on the second attempt if the patient is unable to move their legs?
+Nothing\ test dose is small and short acting - patient must have complete return of leg movement prior to second attempt...
@@TrialImageIncspinal catheters themselves are useful tools. Would you remove the one you've just accidentally inserted? The AOA suggests leaving them in because of their utility and the reduction in PDPH compared to taking them straight out.
You might be grateful for it if the patient later needs LSCS.
doc pls after doing this I have get too much head and waist pain for 4 months now ,what should I do .thanks
Hi Rapture. Sorry to hear of your troubles. You should definitely follow up with your doctor. I wish you well .
Thank you 💚
Hi sir I am the student of B.sc Anaesthesia & operation theatre Tech
That's great Santhiya! You can access my entire library of medical videos at trialimage.com
how do u control the upper level...so that the anaesthetic agent doesnt go beyond that level
+Prachita Srivastava - the epidural space is filled with fatty tissue, and this fatty tissue resists the upward movement of the anesthetic agent. This resistance can be overcome by the dose and rate of medication infusion. Thus, a lower rate of infusion results in a lower level of medication movement in the epidural space, and a higher rate of infusion will result in the medication moving higher in the space. The level of the anesthetic can be determined by careful monitoring of limb sensation, and an anesthetic level that is too high may cause cardiovascular symptoms, nausea and agitation. I hope this helps... CalShipleyMD.com
Thank you...that definitely helped 😊
Maim apka number milega apse bat karna hai kuch
@@priy0553ranjankumar no sorry
Wow teacher❤🙏
i had to go through this and just popped in out of curiosity what i went though. just wow whoever discovered this process.
Thanks for your comment roserry! The epidural anesthetic revolutionized pain control during labor without adverse effects on the fetus You can view my entire medical video library at trialimage.com/
How do the anesthesiologists know when to stop to not to damage the spinal cord?
At the moment the pressure of the syringe drops and the saline solution squirts inside the epidural space
Dr cal Shipley md.. how many times can a doctor stick you in( one) epidural procedure? Please and thank you
Hi - there is no hard limit on how many needle insertions can be performed, but most authorities recommend no more than 2-4 per procedure. Once you have performed that many unsuccessful attempts, you really need to stop and re-evaluate the situation - is there an anatomical or physiological reason for the problem, or is the insertion technique of the operator at fault, and is there a less invasive method available for achieving anesthesia?
Thanks for this great Video.
My pleasure Truth! You can access my entire library of medical videos at trialimage.com
Is their a way to make does pains go away???? Please help
The reason for the epidural is to get rid of the pain. If the pain doesn't go away, they may have administered it wrong, or you may have an allergy to Lidocaine?
Great video, i never leave comments but i did for this because it was really well done. Thank you!
Thank you Stephen - you can access my entire library at trialimage.com
Thank you Stephen! Apologies for the delayed response. You can access my entire medical video library at: trialimage.com
I have ankylosing spondylities. My hip and totally blocked.
Is this the same one my pain doctor said I'd be getting injections in my back for pain I have,I have hernated discs and lumbar radiculopathy plus nerve damage in my right foot and leg,please help its injection for pain,anastetic without steroids as they failed 2wice the steroid injections so I'll be giving just the anastetic injection to help with back pain
A mi me hicieron cuatro hace trece años que no me sirvieron para nada, al final tuvieron que operarme, y ahora me veo que mañana me lo vuelven hacer por que aun operado se ha reproducido la hernia
OMG, I can’t believe what women have to go through!!!
Indeed, pieces of me...
Super helpful !👍🏼 what if it it injected in the wrong place? Is it automatically death for the patient? Or can it be reversible without damage?
Hi Marie - the consequences of an errant injection depend on specifically where and how much of the anesthetic is injected. Theoretically, a misplaced injection could cause serious problems, especially if the continuous drip affects the spinal cord in the area of the heart and lungs. Fortunately, incorrect placement of the anesthetic is rare owing to the test dose that is administered ( as seen in my animation)...trialimage.com
Hi Maritza - a misplaced injection can cause serious side effects, including respiratory arrest. Fortunately, this is very rare provided the test dose is performed as noted in the video...You can access my entire medical video library at: trialimage.com
Very good video. New anaesthesia nurse here.
Thank you Qiong! You can access my entire library of medical videos at trialimage.com
Thanks Qiong! I wish you all the best in your career! You can access my entire medical video library at: trialimage.com
I had an epidural done in 2008 and my body started to shake in an uncontrollable manner.
How does an epidemiologist know when the tuohy needle has reached the epidural space? Is there a difference in the way it feels through the needle?
Yes - there is a sudden feeling of less resistance as the needle enters the epidural space www.CalShipleyMD.com
Anesthesiologist
Or hit the dura sac cause a csf leak now you have the worse headache in your life!!
You will probably feel a relief of pressure, when you reached the cauda equina.
Epidemiologist and anesthesiologist are two separate entity
Can this technique be an alternative to the general anesthesia in a patient with myelomeningocele L3-L4 not tolerating general anaesthesia? Is it possible that that type of anesthesia does not take effect in that case, causing the patient to feel the painful stimulation completely?
Meningoceles can certainly interfere with the spread of local.
They are generally considered a contraindication to any neuraxial anaesthesia, not just epidural.
Why would the patient not tolerate general anaesthesia?
@@joestevenson5568 it ends out in me strongly vomiting for at least 6-7 Times during the next 6 hours since waking up from the surgery. Not a good feeling.
After injection why back side body is to much pain
Good showing through this
Thanks Tulasikondalu - here is a video from my library on Endotracheal intubation trialimage.com/endotracheal-intubation-video-2/
It's so hard to understand without subtitles
Why normal saline is put?
Thanks! this was very well done.
Thank you Gamal!
Yo tengo un parche hematico,que cuidados debo tener y cuanto tiempo dura el dolor de la cadera?
Thanks... 👍 👌 💛
Thank you dr. ♥️
My pleasure Vanlalhruaii! You can access my entire library of medical videos at trialimage.com
I have sciatic pain severe I have never went through sciatic pain like I did the day before yesterday I was in the floor crying I couldn't even get out of the floor and I found out something that really helped me I even went to the hospital and the muscle relaxer they gave me in the more thing did not even help I'm going to be making a video telling what I did to help my sciatic pain and I will demonstrate it and show you what I take too so hopefully I can get this video record it and upload it after I feel a little bit better my leg and my calf is still numb and I still got pain in my back but it's not like it was the day before yesterday
Why heart muscles don't anesthetize when the anesthesiologist anesthetize the body
Hi - only the sensory branches of nerves are anesthetized - no motor (muscular) branches. That's the reason for checking that the patient can move their legs after the test dose. You can access my entire library of medical videos at trialImage.com
very good and thanks!
guoshu feng AL9VE
I love epidural. Because I have a lot of pain while I getting labor my son.epidural looks magic for me because went they injeck me and put the needle of my back it takes me stickles I was laughting a lot .I'm such helrious I dint not feel the pain.two nurse hold my hand .and one doctor I try to turn my back how they put epidural on me because I was curious. I'm not a loud so I heard everything all my tick less in my back it came out men.its feels so good its just they put some raser bleed
Are there side effects after giving birth?
Hi Balance. Side effects after birth are generally minor. There may be some low back soreness briefly as a result of the puncture wound.
Make me want to be anesthesiologist, thank you so much
Glad it was inspirational for you, Bagus! You can access my entire library at www.CalShipleyMD.com
Thank you
Thank you NXD! You can access my entire medical video library at trialimage.com
thank man very helpful
Thank you TheSeeker! Https://www.CalShipleyMD.com
nice video
What is L
thank you very much
+Dr. om prakash gupta - you're welcome, Doctor. You can access my entire library at CalShipleyMD.com
is at possible to fly with an liquorcanal damage, liquorunderpressuere
syndrom(not postpuncture) ? and is it possible to fly with this syndrom
and a subdural hämatoma caused by liquorunderpressure?
What?
@@bekabeka71 It s a disease.
@@OxysLokiMoros my mother is suffering with so much pain after 2 failed back surgeries 😒
@@bekabeka71 but from a spinal fluid leak?
@@OxysLokiMoros from nerve damage and disc bulging
God gift anesthesia
😃👍
Is it normal after 4hour or more receiving epidural anesthesia that you cant even move your leg....i've got an infection on my right thigh nerve,swelling and full of pus so the doctor need to discard it and suggest me to take an epidural anesthesia.....
sir can you upload how to collect csf sample
Does it cause damage to the spinal disc?
Hi Ragesh - the discs are not involved as the injection is placed between them. Https://www.CalShipleyMD.com
If you hit it, maybe??
Or, maybe not? Because it's a pretty.. small incision.. So, it should heal fast. Don't take my word on it, I am still trying to learn. And I am too young to be an MD.
@ sarah hanke
is it important?
Mines was so fucking painful
My girl got thag when given birth now she can't stand her back she gets pain like no other after the whole birth thing ... :( all the time for her rest of her life she's going to have does back pains
send u adres
sir , what is rate of continuous infusion ?
+nepaliman - rate of continuous infusion varies according to the type and concentration of anesthetic medication used, and patient response. If you send me a message through the contact page of my website at CalShipleyMD.com, I can forward an excellent review of epidural anesthesia to you...cjs
Hello, pls, send it to me too: qavtara@yahoo.com ; thank you
do you maybe know what happend to my brother he almost die doing simple surgery of knee he had 10 days 40c temperature not be able to move his head even go to toilet then they take out more fluid from spine and he was better after few days .Thank you so much
Tq
pain managment
L4 L5 L5 s1
very clear
Thank you Prithvi www.CalShipleyMD.com
Sliding back treatment
I want more information about this treatment because I have patient at home .who had been got fractured at L5 and there is no movement from her waist to palm.
Can anybody help me and me more information.
oh heck no ... I'm not taking that thing when it's my time to deliver my baby .. I'd rather be in pain than having a needle inserted into my back
I don’t blame you, Eman. That’s exactly what my daughter said - until she’d been in labor for 9 hours -
You and millions of other women have had the same experience, Sj. It can be immensely helpful...
Eman sweileh we doing that with help of local anesthetic madicine first of all we injact small amount of local becouse of that patient dobt feel needale but some Doctors are dont useing they follow book
that's what I said until I was in labour for 12 hours and then I was willing to take ANYTHING to stop that killing pain :(
Tbh, since there is more pain going on in your abdomen, you can barely feel it.
thank you!
+Christina Nunez - you are welcome Christina www.CalShipleyMD.com
Best hai
Thanks Hai! you can access my entire medical video library at: trialimage.com
Its so amazing men.the dortor and nurses look at me I'm weard .the truth for real men.its the fault s give me tick less while they put epidural on my back OK.he makes me laught I cannot stop it
Great
Thank you mohd- you can access my entire library of Medical Videos at www.CalShipleyMD.com
Help me???
Wht happened
Nice
Thanks Qumar! Https://www.CalShipleyMD.com
Thank you Qumar! You can access my entire library of medical videos at trialimage.com
Thank you Qumar! You can access my entire library of medical videos at trialimage.com
👍👏
Good
Thank you Ahmadnawid. You can access my entire medical video library at www.CalShipleyMD.com
🙏🙏🙏
Thank you Yanaisa! You can access my entire library of medical videos at: www.CalShipleyMD.com
Thanks Yanaisa! You can access my entire medical video library at trialimage.com
👍🏻
Thanks Barbosa - www.CalShipleyMD.com
Thanks Barbosa! You can access my entire library of medical videos at trialimage.com
apke contek nabar mil saktey hey
sr help mee send u adres
How do the anesthesiologists know when to stop to not to damage the spinal cord?
There is no spinal cord below L2. They avoid dural puncture by the loss of resistance technique.
This is all explained very clearly in the video. Rewatch it.
Thank you very much
+hemmojito my pleasure! Http://www.CalShipleyMD.com