Administration of Epidural Anesthesia

Injection at the lumbosacral site:

• Injection at the lumbosacral site is problematic in adult

cattle due to the risk of the needle entering the subarachnoid
space.
• If the needle does enter the subarachnoid space then
proceeding with injection will produce subarachnoid, not epidural,
block. Several hours are required for a hole in the dura to seal.
• In small animals a subarachnoid block may be performed, and
gravity can be used (by positioning of the patient) to control the
extent of neural blockade. This is not a practical proposition with
adult cattle.

Injection at the sacrococcygeal site:

• Provide deep bedding so that the animal will not bruise itself
as it becomes recumbent.
• The injection is carried out as for Caudal Epidural
Anaesthesia of Cattle.
• A larger dose of local anaesthetic agent is used: 100 to 150
ml of 2% lidocaine with 1:200,000 adrenaline for difficult
obstetrical cases.
• Loss of sensation spreads cranially depending on the dose:
"over the croup, between the hind-limbs to the inguinal regions,
prepuce and scrotum, the hind limbs, mammary glands, and finally
flanks and abdominal wall to the region of the umbilicus.
• Motor control of the hind limbs is affected. This varies from
partial to total.
o For partial loss of motor control standing support or
restraint with hobbles in recumbency is required.
o For complete hind-limb paralysis, place the animal in
sternal recumbency with the hind limbs beneath it for at
least 10 to 15 minutes to ensure bilateral analgesia; if
unilateral analgesia is required the animal should be
restrained on itsside; analgesia will develop in the downward
side.
 Note:

paralysis lasts longer than analgesia. With full paralysis the animal will
be unable to rise for two hours or longer and may remain ataxic for
three to four hours or more. The animal should be maintained in
sternal recumbency with the legs hobble until full motor function has
returned.

o When motor power has returned to the tail it is

probable that the animal will be able to rise and stand.

Segmental epidural block:

Correct dosing of agents at this site allows production of a "belt" of

analgesia without affecting the hind limbs.

• Restrain the animal in a standing position.

• Identify the site for needle insertion, just to the right of
the lumbar spinous process, 1.5 cm behind the cranial edge of the
second lumbar transverse process.
• Using a fine needle inject an initial skin weal of local
anaesthetic.
• Incise the skin in a 2 to 3 cm incision longitudinally.
• Insert a 14 gauge 12 cm spinal needle, directed at an angle of
10-13 degrees to the vertical ventrally and medially from the
insertion point for a distance of about 7.5 cm; at this point the
neural canal will be entered.
• Penetration of the interarcuate ligament appears to be
painful even if small quantities of local anaesthetic are injected
along the track of the needle. Adequate restraint is important.
• As soon as penetration of the interarcuate ligament is felt,
withdraw the stilette from the needle; if air is heard entering the
needle then the epidural space has been entered.
o Make a trial injection to confirm correct placement:
there should be practically no resistance to injection.
• If cerebrospinal fluid flows from the needle when the
stilette is withdrawn, gently and quickly withdraw the needle until
the flow stops, then inject.
Appropriate Use:

Lumbosacral epidural block may be used for: "difficult manipulative

reposition; extensive embryotomy; amputation of the prolapsed uterus;
caesarean section; examination of and operation on the penis; cutting
operations about the prepuce and inguinal regions; castration; operative
interferences on the udder; operations on the hind limb such as
amputation of the digit.

Notes:

Cardiovascular responses to segmental lumbar block T13 to L1:

• These changes do not appear to be of clinical significance.

• Reduced mean arterial pressure.
• Increased carbon dioxide due to increased heart rate which
occurs as a response to decreased vascular resistance.

Complications/ Limitations / Risk:

• With injection from the caudal epidural (sacrococcygeal)

site, satisfactory cranial spread for lumbar epidural block is not
always achieved.
• Lumbosacral epidural with lumbosacral injection: The
needle may enter the subarachnoid space, in which case proceeding
with injection will produce subarachnoid, not epidural, block.
Several hours are required for a hole in the dura to seal.
• There is a risk of infection particularly if vaginal
examination has been carried out with a dead/putrid fetus present
prior to the injection being made, or if a second injection is
required.
• There is a risk of development of hypotension.

Equipment / Chemicals required and Suppliers:

• Local anaesthetic solution e.g. 2% lidocaine hydrochloride.

• A spinal needle.
• Syringe.