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  • 1. Preparation
  • 2. Epidural Administration
  • 3. Confirmation of Placement and Test Dose Administration
  • 4. Securing the Epidural Catheter
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Epidural at T9-T10: Preoperative for HIPEC Surgery

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Xiaodong Bao, MD, PhD
Massachusetts General Hospital

Transcription

CHAPTER 1

A little cleaning solution here. And - we're doing an epidural for you right now. So... For his HIPEC case - all right, 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. A little plastic drape coming on your back.

CHAPTER 2

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. He's someone who has very tensile skin. Just some numbing medicines, okay? Some more numbing medicine here. Perfect. All right.

You may feel some pressure in the back. Keep in the middle. So now Dr. Wu is using the 17 guage Tuohy needle. Yeah. Yeah. When it goes through... The sub-q skin - you can go a little bit more if you engage. Yeah. Yeah. Square it. A little bit. I'm in there now. Okay. So we're going to engage at the ligamentum flavum. Okay. A little bit tighter? Not yet. It's a little bit tighter. 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 the catheter. It's 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 the epidural needle is out. Okay? Needle is out. You can relax.

CHAPTER 3

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... All right, so we're going to test our epidural. We're going to aspirate first - make sure that no CSF comes back. Negative aspiration. Okay, so that's what we call the negative aspirations, and 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.

CHAPTER 1

Now we're going to secure the epidural catheter. So that depends on drying it a bit. Okay.