Epidural Space

Compression of the IVC by the gravid uterus results in increased venous pressure below the level of the obstruction. Venous blood is then diverted through vertebral plexuses within the epidural space and this causes epidural veins to become engorged. Consequently, the epidural volume is reduced and any solutions injected into the lumbar epidural space will spread more extensively.

CNS CHANGES DURING PREGNANCY

Parameter

Change

MAC of volatile anaesthetic agents

i

Beta endorphins

Epidural space volume

i

Epidural space pressure

Cerebrospinal fluid pressure

Cerebrospinal fluid volume

i

Cerebrospinal fluid composition

nil

Cerebrospinal fluid pH

Sensitivity to local anaesthetics

Local anaesthetic dose requirements

Figure PN.10

Pressure in the epidural space of non pregnant patients is usually negative (-1 cmH2O), but in the pregnant woman, it is slightly positive. During contractions, the epidural pressure rises by 2-8 cmH2O, while during expulsion, it ranges between 20 and 60 cmH2O.

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