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How to Perform Central Neuraxial Blockage and Its Types  - ANESTHESIA

Jul 10, 2023

Central Neuraxial Blockage

Anesthesia or analgesia is administered by injecting drugs into the central nervous system, which is referred to as central neuraxial blockage, neuraxial anesthesia, or regional anesthesia.

It involves aiming at the spinal cord or the area surrounding the spinal cord. These methods are frequently employed during surgeries, particularly to control labor and delivery-related discomfort.

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Types Of Central Neuraxial Blockage

There are primarily two types of central neuraxial blockages:

  • Spinal Anesthesia- A small amount of local anesthesia is injected into the subarachnoid space, which surrounds the spinal cord and is filled with cerebrospinal fluid. Below the level of injection, the drug inhibits muscular contractions and nerve impulses.
  • Epidural Anesthesia-  Local anesthesia is given in the epidural space, which is just outside the dura mater, the outermost membrane enclosing the spinal cord. Regional anesthesia and analgesia are produced by the medicine as it diffuses to the nerve roots and inhibits pain signals.

How To Perform Central Neuraxial Blockage?

A central neuraxial blockage is normally carried out by an anesthesiologist and needs skill and attention to aseptic procedures. The following methods are used to perform it:

  • Patient positioning- It involves properly putting the patient in a seated, prone, or lateral decubitus posture according to the procedure chosen. Examine the patient in order to make sure that they're stable and comfortable.
  • Pre-procedure preparation - After explaining the procedure, risks and advantages, and other options, acquire the patient's informed permission. To maintain a sterile environment, make sure the patient is prepped and draped correctly.
  • Identify the needle insertion- Locate the anatomical landmarks required for the chosen techniques and the needle insertion site. In the lumbar or sacral area, locate the required interspinous space for spinal anesthesia and the required intervertebral space in the lumbar or thoracic area should be identified for epidural anesthesia.
  • Skin preparation and local anesthesia- To reduce the risk of infection, thoroughly clean the insertion site. In order to reduce pain during needle insertion, local anesthesia should be applied to the skin and subcutaneous tissue.
  • Needle insertion- Insert a clean, suitable-sized needle for the technique you've chosen. For spinal anesthesia, a needle is inserted into the subarachnoid space through the skin, subcutaneous tissue, and ligaments; for epidural anesthesia, the needle is inserted through the skin, subcutaneous tissue, and ligaments; and into the epidural space.
  • Medicine administration- Once the needle has been successfully placed during medicine delivery, inject the desired area with local anesthesia. Slowly inject while keeping an eye on the patient's reaction and searching for any complications or side effects.
  • Catheter placement- In the case of epidural anesthesia, after the medication has been delivered and its location has been verified, a catheter may be introduced through the needle into the epidural area. Long-term pain management is made possible by using this catheter for continuous medication administration.
  • Monitoring and management- It involves monitoring the patient's vital signs, such as their level of sedation, oxygenation, and responsiveness to a blockade, and adjusting their drugs accordingly. Supportive care is also given to keep the patient stable and to deal with any adverse effects or consequences.

Side Effects of Central Neuraxial Blockage

Spinal anesthesia, epidural anesthesia, and other forms of central neuraxial blocking are generally regarded as safe. It does, however, have some dangers and potential adverse effects. Among the potential negative effects of central neuraxial obstruction are:

  • Hypotension
  • Headache: A post-dural puncture headache is a potential side effect of central neuraxial obstruction, especially if the dura mater was accidentally punctured during needle insertion. Neck discomfort and other symptoms may also accompany this headache, which is often made worse by being upright.
  • Backache: Some individuals report backaches or other localized discomfort near the epidural injection site. Usually only short-lived, this soreness goes away on its own.
  • Injury to the nerves: Although i is extremely rare, there is a very slight probability that the central neuraxial obstruction will cause nerve injury. Some neurological symptoms, such as numbness, tingling, weakness, or paralysis, may develop permanently as a result of nerve damage.
  • Infection- Any invasive procedure raises the possibility of infection. The danger of infection can manifest at the location of the needle insertion with central neuraxial obstruction.

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