Spinal and epidural anesthesia should be performed only after appropriate monitors are applied in a setting in which equipment for airway management and resuscitation is immediately available.

1. Needles
   1. Spinal and epidural needles are named for the design of their tips (“pencil point,” beveled tip with cutting edge) (Fig. 34-3: Examples of commercially available spinal and epidural needles).
      1. Epidural needles have a larger diameter than spinal needles, facilitating injection of air or fluid for the “loss of resistance” technique and passage of catheters.
      2. The outside diameters of spinal and epidural needles are used to determine their gauges. Large-gauge spinal needles (22–29 gauge) are often easier to insert if an introducer (inserted into the interspinous ligament) is used. Postdural puncture headache (PDPH) is less likely when small-gauge spinal needles are used.
   2. All spinal and epidural needles come with a tight-fitting stylet to prevent the needle from becoming plugged with skin or fat.
2. Sedation before placement of the block is limited because patient cooperation (positioning, determination of level of sensory anesthesia, occurrence of paresthesias) is important. After the anesthesia is established, the patient may be sedated as deemed appropriate.

Epidural and Spinal Anesthesia

1. Anatomy
2. Technique
3. Spinal Anesthesia
4. Continuous Spinal Anesthesia
5. Epidural Anesthesia
6. Continuous Epidural Anesthesia
7. Epidural Test Dose
8. Combined Spinal–Epidural Anesthesia
9. Pharmacology
10. Physiology
11. Complications
12. Contraindications
13. Choice of Spinal or Epidural Anesthesia