Preface

The epidural space around the spinal cord is one of the most explored and exploited spaces in human anatomy. The last two decades have seen an exponential increase in the use of the epidural space to administer medications to enhance anaesthesia and analgesia, opening a new horizon in the management of patients in clinical settings.

*Epidural Administration - New Perspectives and Uses* focuses on recent advances in the exploration and exploitation of this space. The first chapter of this unique book reviews the various ways of achieving epidural administration of agents into the epidural space. Chapter 2 describes the loss of resistance (LOR) technique, the preferred method for identifying the epidural space, and explains how a sudden change in resistance is detected with the passage of the epidural needle tip from the ligamentum flavum into the epidural space. The third chapter provides insight into this complex and comprehensive topic to demonstrate a predictable pattern that can provide a safe and accurate guide to clinical practice. Chapter 3 also highlights the many factors that have an impact on drug physiology and pharmacology in the epidural space, and discusses how epidural anaesthesia or the expected effect of another medication can be modified.

Chapter 4 covers basic anatomical considerations, general and obstetric physiology, epidural techniques and position, the use of ultrasound for epidural placement, pharmacological drugs used in epidurals, complementary and supplementary regional blocks with epidurals, other remedies when epidurals are not viable or fail, and local anesthesia systemic toxicity. Chapter 5 discusses lumbar disc degeneration as a common progressive, chronic disorder and a major cause of low back pain. The authors show that epidural platelet-rich plasma injections can cause a significant release of growth factors to improve the healing of wounds and the processes of tissue regeneration, and in the treatment of cellular involution that takes place with aging.

Adequate pain control in the intensive care unit (ICU) is essential and adds to optimal patient care with improved outcomes. However, epidural administration of opioids is rarely considered in patients in ICU experiencing significant pain. Chapter 6 describes how epidural administration of various analgesics can be used to manage the pain experienced by these critically ill patients. Chapter 7 highlights the importance of human, technical and economic resources as prerequisites for effective epidural services. It suggests ways of tackling the constraints experienced in low- and middle-income countries.

The chapters in this book are well-written by authors with in-depth knowledge of the topics. The book will be a good armamentarium for all anaesthetists in clinical practice.

> **Sotonye Fyneface-Ogan** Professor, Obstetric Anaesthesia Unit, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

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Section 1

Identification of the Epidural

Space

Section 1
