USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

(Kiana) #1

Epidural block is a mode of conduction anesthesia that involves injection of
local anesthetic into the epidural space to block the lumbosacral nerve roots
during both stages 1 and 2 of labor. Advantages include use for either vaginal
delivery or cesarean section. Disadvantages include patchy block from
nonuniform spread of the local anesthetic around the nerve roots. Complications
include hypotension from peripheral vascular dilation owing to sympathetic
blockade and spinal headache from inadvertent dural puncture, as well as CNS
bleeding or infection (rare). Hypotension is treated with IV fluids and IV
ephedrine. Spinal headache is treated with IV hydration, caffeine, or blood patch.

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