Potential Space and Epidurals

[BeatOU]

So my wife goes into labor, gets an epidural, and of course I'm all over watching it being placed. The CRNA was great, showed me how to do it, talked about school with me, and was overall awesome.

And now I have some questions.

First, she talked about the epidural space being a "potential space", could someone take the time to explain?

My other question involved learning to place them. Though it can be a painful experience, learning a skill like an IV or NG placment the chances of massive injury are/seem remote, whereas poking around the spine seems as though it could cause some complications...I'd like to hear how people were taught at different schools?

Thanks,

Andy

[versatile_kat]

The subdural space is known as a potential space that lies between the dura and the arachnoid membranes. It's called a "potential" space because it normally does not exist. Here is a quick link http://www.burtonreport.com/infspine/EpiduralSteroidAnatomy.htm

As far as technique ... you comparing it to IV starts is not far off from the truth. Just like any skill, it takes repetition and good coaching to become proficient. At our program, we go to an affiliate site for a month (a birthing center) and start labor epidurals the entire time. Some of my classmates think starting an epidural is easier than placing a spinal.

Good luck in school.

[miloisstinky]

Potential meaning you make the space by injecting a volume of liquid (narcotics, saline, local anesthetics), the space expands/opens up as you inject even 40-50 ml's.

And it helps to know the spinal cord ends at L2, so you can't "stab" the cord with your needle if you advance it too far. You may get a spinal headache because if you have punctured the dura layer, that nice cerebral spinal fluid that cushions the brain and the cord will leak out and "skwoosh" the brain....headache! (like my simplicity?...thanks:rotfl: )

[apaisRN, RN, CRNA]

If the patient is free of risk factors like coagulopathy (hematoma risk) or infection (epidural abcess, very bad) there's really not a lot you can do to seriously hurt someone while placing a spinal or epidural. I was petrified of neuraxial anesthesia and while my skills are still rudimental, I now approach the patient with much less anxiety. Worst case is generally headache or unsuccessful block.

An ugly airway, now, that's scary.