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## Meet the editor

Sotonye Fyneface-Ogan is a teacher and pioneering researcher in the field of obstetric anaesthesiology with a special interest in the epidural space and its uses. He is a professor of obstetric anaesthesiology and a lecturer at the Faculty of Clinical Sciences of the University of Port Harcourt, Nigeria. Currently, Prof. Fyneface-Ogan heads the Obstetric Anaesthesia Unit of the University of Port Harcourt Teaching Hospital. He is a senior exam-

iner in the Faculty of Anaesthesia, West African College of Surgeons, and a trainer in obstetric anaesthesia for the World Federation of Societies of Anaesthesiologists.

### Contents



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

*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

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

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

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