Top epidural Articles in Anesthesiology

Minimum Current Requirements for Epidural Stimulation Test Confirmation of Epidural and Intrathecal Catheter Placement
Regional Anesthesia and Pain Medicine, 11/04/2009

Sutherland MA et al. – The epidural stimulation test is designed to confirm the correct epidural location of a catheter but may also detect unintended intrathecal catheter ... minimum electrical current required for appropriate motor stimulation. The epidural stimulation test minimum electrical current requirement seems to be lower for intrathecal compared with epidural catheter placement. [more...]

Techniques of epidural block
Anaesthesia & intensive care medicine, 11/05/2009

Fischer B – Spinal, epidural and caudal blockade are the three components of central neuraxial blockade, and provide surgical anaesthesia and postoperative analgesia for sub–umbilical surgery (thoracic epidurals provide effective analgesia but not ... thoracic and upper abdominal surgery). Epidural and caudal blockade have a number of synonyms, which can be confusing. The terms ‘epidural’ (extradural, peridural) and ‘caudal’ (sacral epidural) are used throughout this article. [more...]

Analysis of individual patient data from clinical trials: epidural morphine for postoperative pain
British Journal of Anesthesia, 11/05/2009

Mhuircheartaigh NR et al. – There were three strong findings. Epidural morphine resulted in greater patient satisfaction, despite higher rates of adverse events. Those describing their ... significantly above the mean. Epidural morphine meant less need for postoperative IVPCA opioid than epidural placebo. The therapeutic gain with EREM was lower pain scores with less IVPCA opioid. Moderate or severe pruritus was more common with IVPCA plus epidural morphine, whatever the formulation ... of new agents not immediately apparent from original trials, and also informing clinical practice. Prophylactic epidural morphine provides a better patient experience than IVPCA alone. [more...]

Incidence of Simultaneous Epidural and Vascular Injection During Cervical Transforaminal Epidural Injections
Spine, 10/09/2009

Smuck M et al. – Simultaneous epidural and vascular injection accounts for over half of all vascular injections during cervical transforaminal epidural injections. With the risk of ... high incidence of vascular injections in the cervical spine, live fluoroscopy is recommended during contrast injection with specific attention to simultaneous epidural and vascular flow. [more...]

Is Intravenous Patient Controlled Analgesia Enough for Pain Control in Patients Who Underwent Thoracoscopy?
Journal of Korean Medical Science, 10/01/2009

Kim JA et al. – Epidural patient–controlled analgesia (Epidural PCA) and intravenous patient–controlled analgesia (IV PCA) are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA. Methods ... Prospective randomized study. 52 patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous ... score, and the incidence of side effects. Results 37 patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score [more...]

Techniques for epidural injections
Techniques in Regional Anesthesia and Pain Management, 11/20/2009

Patel VB – Epidural steroid injections (ESIs) are routinely used for the treatment of a variety of spinal ailments. Various methods for accessing the epidural space have been described over the decades. In the recent past, more and more emphasis has been on ... delivery of drugs to the site of pain generation. Techniques differ according to the level of epidural space accessed. Use of fluoroscopic guidance can provide the most precise delivery of the drug. Although relatively safe, these injections can lead to morbidity and mortality if performed in a ... ndash;opaque contrast material cannot be underestimated. The following chapter will summarize these techniques and highlight various technical considerations for the epidural injections. [more...]

Evidence-based practice of lumbar epidural injections
Techniques in Regional Anesthesia and Pain Management, 11/20/2009

Datta S et al. – Recent guidelines by the American Society of Interventional Pain Physicians and others have evaluated effectiveness of caudal epidural steroid injections (ESIs), transforaminal, and interlaminar injections separately. The ... that caudal ESIs are superior to the interlaminar epidural injections and equal to transforaminal epidural injections. In addition, the response to epidural injections for various pathologic conditions (disc herniation and/or radiculitis, discogenic pain without disc herniation, spinal stenosis ... and discogenic pain without disc herniation or radiculitis. They also indicated evidence is Level II–1 or II–2 evidence for caudal epidural injections in managing pain of postlumbar surgery syndrome and lumbar spinal stenosis. They also provided strong recommendations of 1B or 1C for ... laminectomy syndrome, and spinal stenosis. [more...]

The mechanism of action and side effects of epidural steroids
Techniques in Regional Anesthesia and Pain Management, 11/20/2009

Baqai A et al. – This paper assesses the multiple mechanisms of action of epidural steroids in the treatment of back pain on the mechanical, cellular, and molecular levels and reviews the systemic side effects of epidural steroid usage. A review of ... ndash;aided search of recently published articles within the last 10 years to find the most recent information on the mechanism of action of epidural steroids. The studies discussed in this paper focus on the theories underlying the various anti–inflammatory actions of glucocorticoids, as well [more...]

Intraoperative Epidural Catheter Migration Into Subarachnoid Space Leading To Massive Subarachnoid Injection Of Morpine
Middle East Journal of Anesthesiology, 10/26/2009

Mishra P et al. – Epidural catheter may migrate into subarachnoid space in the intra–operative course of event even if test dose and aspiration were negative. It may ... omit morphine from first epidural dose to avoid massive subarachnoid administration of morphine. [more...]

Symptomatic Epidural Gas Cyst Associated With Discal Vacuum Phenomenon
Spine, 10/09/2009

Kakitsubata Y et al. – Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous ... collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar [more...]