Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia3. Following successful catheter insertion a large area should belightly sprayed with Opsite spray to make the skin tacky.4. Apply a Tegaderm dressing over the insertion site. Do not coverthe insertion site with gauze as this prevents adequateobservation of the insertion site.5. Apply a one-inch strip of Mefix or Sleek tape along the edges ofthe Tegaderm.6. Use a one-inch strip of Mefix or Sleek to secure the free catheterto the patient’s back and continue it over the shoulder.7. Use some gauze to make a cushion and place the epidural filteron top of it on the upper anterior chest wall and secure withMefixHigh epidural blockDefinitionA high block is defined as loss of cold sensation at or above thenipple line (T4). It may present with hypotension, nausea, sensoryloss or paraesthesia of high thoracic or even cervical nerve roots(arms) and may endanger the patient by causing respiratory difficultydue to blockade of nerve supply to intercostal muscles.Causes of a high block:• Infusion rate too high.• Recent bolus dose.• Migration of epidural catheter into the CSF.Signs and Symptoms:1. Loss of cold sensation at or above the nipple line (T4).Danger Signs:2. Weakness or numbness in hands or arms, unable to perform ahand grip.Anaesthetists Handbook January 2010 135