Epidural Anesthesia Diagram

 

Epidural Anesthesia Diagram

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Epidural Anesthesia Diagram

Epidural Anesthesia Diagram

A. Palpation of sacrococcygeal ligament. B, C. Sacrum cut to show needle position. D. Position of patient.

In living persons, the sacral hiatus is closed by the membranous sacrococcygeal ligament, which is pierced by thefilum terminale (a connective tissue strand extending from the tip of the spinal cord to the coccyx). Deep (superior) to the ligament, the epidural space of the sacral canal is filled with fatty connective tissue. In caudal epidural anesthesia or analgesia , anesthetic or analgesic agents are injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves. This can be accomplished by several routes, including the sacral hiatus. Because the sacral hiatus is located between the sacral cornua and inferior to the S4 spinous process or median sacral crest, these palpable bony landmarks are important for locating the hiatus. The agent spreads superiorly and extradurally, where it acts on the S2–Co1 spinal nerves of the cauda equina. The height to which the agent ascends is controlled by the amount injected and the position of the patient. Sensation is lost inferior to the epidural block. Anesthetic and analgesic agents can also be injected through the posterior sacral foramina into the sacral canal around the spinal nerve roots ( transsacral epidural anesthesia ) . Epidural anesthesia during childbirth is discussed in Chapter 6 , Pelvis and Perineum.

Source: Clinically Oriented Anatomy

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