The patient is undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) for which he is receiving an epidural block placed at T9-T10 before undergoing the procedure. Epidural injection refers to drug administration to the epidural space surrounding the spinal cord in the vertebral column. The epidural space can be entered in the cervical, thoracic, lumbar, or sacral regions. It is often used to achieve anesthesia in the spinal segments below the site of placement of the epidural catheter. The site of injection in the patient’s back is prepared with a cleaning solution, followed by injection of a local anesthetic to numb the site where the epidural needle will be placed. An epidural needle is inserted in the numbed area until it reaches the epidural space. Negative aspiration upon testing indicates correct placement of the catheter. A catheter is then threaded into the epidural space followed by administration of a test dose ensure correct placement.
Part 2: Cystoscopy and Placement of Uretal Stents, performed by Dr. McGovern. Found at jomi.com/article/218.2
Main text coming soon.
Little cleaning solution here. It's a HIPEC surgery, where they're going to remove my uh - appendix, spleen, and part of my colon. Okay. Now I take a low dose aspirin every day, but I did not take one today. Okay. And - we're doing an epidural for you right now. So… For his - HIPEC case, alright we're typically putting the epidural at the T9 to T10. After wide skin prep - Dr. Wu will put a plastic drape on the back. Little plastic…
You’re going to feel a little numbing medicine, this will be a little pinch and burn. Okay - so, Dr. Wu will start with - some local anesthetic. So he - he's someone who has really tensile skin. Just some numbing medicines, okay? Some more numbing medicine here. Perfect. Poke. Okay. Go back. Alright.
You're going to feel some pressure in the back. Keep in the middle. Yeah, I'll talk about it, so - now Dr. Wu is using the 17 guage Tuohy needle. Yeah. Yeah. the sub q skin - you can go a little bit more if you engage. Yeah. A little bit. Okay. So we're going to engage at the ligamentum flavum. Okay. A little bit tighter. Not yet. A little bit tighter. It looks tighter now. So we're at the ligamentum flavum. Okay, we can adjust our needle a little bit. We use lots of resistance to saline. Yeah. So you can see the change of the resistance. Don't move - you're doing great.
So we lost at the 5? That's - 8, 7. So this is 8, 7, 6, probably 5. We're trying to thread in a catheter. Is threading easy? Yeah, I think so. Very easy. Okay.So then, we're going to remove the epidural needle. It's okay, that's enough. Okay. That's it. So epidural needle is out. Okay? Needle is out. You can relax.
Just a little piece of plastic here. Okay, you have just a small catheter out of your back. We just need to test it, and then secure it. Okay? So what Dr. Wu will do is pull back the epidural catheter. We'll leave 5 cm at the epidural space, so we leave at - 11? Yeah. Because 15, 14, 13, - 12, and - a little bit more. Okay. And then we'll give what we call the test dose, which is… Alright, so we're going to do a - test our epidural, we're going to to aspirate first - make sure that no CSF comes back. Negative aspiration. Okay, so that's what we call the negative aspirations, then we'll inject 3 cc of 1.5% of Lidocaine with epinephrine. We look at the patient's heart rate. Let us know if you feel any weird side effects. Any kind of weird numbness or metallic taste in your mouth, weird sensations in your legs, ringing in the ears. We don't expect any of that to happen, but if it does, let us know. Everything is perfect. You're doing really well. Okay? No change of heart rate. And then we're going to check the blood pressures. Yeah.
Now we're going to secure the epidural catheter. So that depends on drying it a bit. Okay.