Extradural anaesthesia

Abouleish El, Elias M, Nelson C. Ropivacaine-induced seizure after extradural anaesthesia. Br J Anaesth 1998 80(6) 843-4. 

Hut H, Gramm HJ, Link J. Changes in intracranial pressure associated with extradural anaesthesia. Br J Anaesth 1986 58(6) 676-80. 

Pretreatment with oral ranitidine 150 mg 1.5 to 2 hours before bupivacaine for extradural anaesthesia for caesarean section, increased the maximum plasma levels of bupivacaine in 10 patients by about 36%, when compared with 10 patients given no pretreatment. Another study found that two oral doses of ranitidine 150 mg caused a 25% increase in the mean AUC of bupivacaine, but this was not statistically significant. No increased bupivacaine toxicity was described in any of these reports. However, two other studies in 36 and 28 women undergoing caesarean section found no measurable effect on the bupivacaine disposition when given ranitidine 150 mg the night before and on the morning of anaesthesia, or ranitidine 50 mg intramuscularly 2 hours before anaesthesia, respectively. ... 

In selected cases the full range of techniques of local and regional anaesthesia may be used, including extradural and intrathecal morphine (p. 360). 

Extradural (epidural) anaesthesia is used in the thoracic, lumbar and sacral (caudal) regions. Lumbar epidurals are used widely in obstetrics and low thoracic epidurals provide excellent analgesia after laparotomy. The drug is injected into the extradural space where it acts on the nerve roots. This technique is less likely to cause hypotension than spinal anaesthesia. Continuous analgesia is achieved if a local anaesthetic, often mixed with an opioid, is infused through an epidural catheter. 

Beck GN, Griffiths AG. Failed extradural auaesthesia for caesareau sectiou. Complicatiou of subsequent spinal block. Anaesthesia 1992 47(8) 690-2. 

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