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Unlike the cranial epidural space, the spinal epidural space contains adipose tissue, the internal vertebral venous plexuses and the spinal nerve roots. [1] The spinal epidural space spans the length of the spinal cord, from the foramen magnum superiorly to the sacral hiatus inferiorly. [6] Epidural space is the smallest at the cervical region ...
Epidural administration (from Ancient Greek ἐπί, "upon" + dura mater) [1] is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics , diagnostic medicines such as ...
For epidural anesthesia an anesthetic agent is injected into the space just outside the thecal sac and diffuses through the dura to the nerve roots where they exit the thecal sac. [4] [5] For spinal anaesthesia in general, an injection can be given intrathecally into the subarachnoid space, or into the spinal canal.
A spinal anaesthetic delivers drug to the subarachnoid space and into the cerebrospinal fluid (CSF), allowing it to act on the spinal cord directly. An epidural delivers drugs outside the dura (outside CSF), and has its main effect on nerve roots leaving the dura at the level of the epidural, rather than on the spinal cord itself.
The internal vertebral venous plexuses (intraspinal veins) lie within the vertebral canal in the epidural space, [1] [2] embedded within epidural fat. [2] [3] They receive tributaries from bones, red bone marrow, and spinal cord. They are arranged into four interconnected, vertically oriented vessels - two situated anteriorly, and two ...
The dura mater covering the spinal cord is known as the dural sac or thecal sac, and only has one layer (the meningeal layer) unlike cranial dura mater. The potential space between these two layers is known as the epidural space, [5] which can accumulate blood in the case of traumatic laceration to the meningeal arteries.
The spinal needle is then withdrawn and the epidural catheter inserted in the standard manner. Alternatively, a two-level approach may be undertaken. The epidural space is first located in the standard manner. Then, at another level, a standard spinal is performed. Finally, the epidural catheter is threaded through the Tuohy needle.
The spinal cord (and brain) are protected by three layers of tissue or membranes called meninges, that surround the canal. The dura mater is the outermost layer, and it forms a tough protective coating. Between the dura mater and the surrounding bone of the vertebrae is a space called the epidural space.
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