Clinical Pearls

"Success covers a multitude of blunders" ^* is an appropriate adage for the use of epidural anesthesia. To be successful, the anesthesiologist must perform the technique often enough to be technically facile. To increase the use of the technique, several practical observations may be helpful.

If catheters can be avoided during epidural anesthesia (e.g., by selecting the appropriate local anesthetic), a potential source of difficulties with the technique can be avoided. It is important to allow the block enough "soak time" before the surgical procedure; this can be facilitated if the block is carried out in an induction room separate from the operating room. The anesthesiologist must recognize that there appears to be a plateau effect in dosing epidural local anesthetics. After some quantity of the local anesthetic has been injected, additional local anesthetic does not significantly increase the block height but may instead make the block more dense (i.e., improve quality).^[185] To be successful with the technique, the anesthesiologist should be prepared at all times to treat complications associated with epidural anesthesia: airway equipment, drugs, and especially oxygen and resuscitation must be immediately available.