scholarly journals Potential Intrathecal Leakage of Solutions Injected into the Epidural Space following Combined Spinal Epidural Anaesthesia

1998 ◽  
Vol 26 (3) ◽  
pp. 256-261 ◽  
Author(s):  
A. Vartis ◽  
C. B. Collier ◽  
S. P. Gatt
Keyword(s):  
Epidural Catheter ◽  
Bolus Dose ◽  
Dural Puncture ◽  
Puncture Site ◽  
X Ray ◽  
Combined Spinal Epidural ◽  
Fluoroscopic Control ◽  
Close Proximity ◽  
Epidural Anaesthetic ◽  
Spinal Epidural

A combined spinal epidural anaesthetic (CSE), by design, produces a deliberate multicompartment block across a breached dural membrane. Since the lateral holes of the epidural catheter may lie in close proximity to the dural puncture site, a bolus solution of drug injected via the epidural catheter has the potential to leak through the dural puncture into the subarachnoid space. The aim of this study was to determine the incidence of intrathecal leak by performing an epidurogram. Fifteen patients undergoing surgery with a CSE anaesthetic using a 16 gauge Tuohy/26 gauge pencil point needle were studied. Within three hours of catheter insertion, 12 ml of contrast (iohexol 300 mg/ml) was injected via the epidural catheter under fluoroscopic control with screen recording and exposure of lateral and anteroposterior X-ray plates. All films were later reviewed for evidence of intrathecal spread. We did not observe any evidence of intrathecal spread of contrast. However, caution should be observed during administration of an intraoperative bolus dose of analgesic agent via a catheter inserted as part of a combined spinal epidural anaesthetic technique, particularly with the use of hydrophilic opiods.

Dural Puncture with a 27-Gauge Whitacre Needle as Part of a Combined Spinal–Epidural Technique Does Not Improve Labor Epidural Catheter Function

2005 ◽  
Vol 103 (5) ◽  
pp. 1046-1051 ◽  
Author(s):  
John A. Thomas ◽  
Peter H. Pan ◽  
Lynne C. Harris ◽  
Medge D. Owen ◽  
Robert D’Angelo
Keyword(s):  
Epidural Catheter ◽  
Drug Administration ◽  
Dural Puncture ◽  
Labor Analgesia ◽  
Replacement Rate ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Unilateral Block ◽  
Spinal Epidural ◽  
Catheter Function

Background This prospective, double-blind, randomized study was designed to examine whether the combined spinal-epidural technique without subarachnoid drug administration improved epidural catheter function when compared with the traditional epidural technique. Methods After institutional review board approval and informed consent, 251 healthy laboring parturients were randomly assigned to either group DP (combined spinal-epidural technique with 27-gauge Whitacre needle dural puncture but without subarachnoid drug administration) or group NoDP (traditional epidural technique). Patient-controlled epidural analgesia was initiated with 0.11% bupivacaine and 2 microg/ml fentanyl. Top-up doses in 5-ml increments of 0.25% bupivacaine were administered if needed. Previous power analysis revealed that a sample size of 108 patients/group was needed to show a clinically useful reduction of the catheter manipulation rate from 32% to 15%. Results In groups DP and NoDP, 107 and 123 evaluable patients, respectively, completed the study. Demographics and outcome variables measured, including epidural catheter manipulation and replacement rate, sacral sparing, unilateral block, number of top-up doses, average hourly epidural drug usage, highest sensory blockade level, and labor analgesia quality, were not different between groups. A subgroup of 18 patients without cerebral spinal fluid return during dural puncture had a higher catheter replacement rate than those of groups DP and NoDP, but it did not reach statistical significance. Conclusions Dural puncture with a 27-gauge Whitacre needle without subarachnoid drug administration during combined spinal-epidural labor analgesia did not improve epidural labor analgesia quality or reduce catheter manipulation or replacement rate when compared with a traditional epidural technique.

COMBINED SPINAL EPIDURAL ANALGESIA IN LABOUR

2005 ◽  
Vol 16 (1) ◽  
pp. 29-50 ◽  
Author(s):  
MARGO LEWIS ◽  
NICOLA CALTHORPE
Keyword(s):  
Epidural Catheter ◽  
Pain Control ◽  
Rapid Onset ◽  
Motor Blockade ◽  
Operative Delivery ◽  
Single Procedure ◽  
Combined Spinal Epidural ◽  
Post Operative Pain ◽  
Spinal Epidural ◽  
Speed Of Onset

The combined spinal epidural (CSE) as an anaesthetic technique for providing analgesia for labour and anaesthesia for operative delivery has gained in popularity over the last ten years. Essentially the CSE consists of identification of the epidural space and insertion of an epidural catheter plus the initial intentional placement of an intrathecal dose of opioid, local anaesthetic or both, all as a single procedure. Theoretically the technique combines the advantages of the speed of onset and the reliability of block achieved by subarachnoid anaesthesia with the flexibility provided by the presence of an epidural catheter and avoids their individual disadvantages. The complications that may be encountered are those attributable to subarachnoid and epidural anaesthesia individually but some are unique to the CSE technique. The CSE technique is also applicable to other situations in obstetrics where a block is initiated by subarachnoid anaesthesia and its continuation is facilitated by the presence of an epidural catheter, either to maintain anaesthesia for prolonged procedures or for post operative pain control. The CSE's popularity has been ensured by the fact that it has allowed rapid onset analgesia with minimal motor blockade to be provided routinely for mothers in labour.

scholarly journals Effect of pre-administration with aminophylline on the occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia

2018 ◽  
Vol 47 (1) ◽  
pp. 420-426
Author(s):  
Chao-Jie Yang ◽  
Tao Chen ◽  
Xin Ni ◽  
Wan-You Yu ◽  
Wei Wang
Keyword(s):  
Side Effects ◽  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Dural Puncture ◽  
Demographic Data ◽  
Operation Time ◽  
Post Dural Puncture Headache ◽  
Combined Spinal Epidural ◽  
Group A ◽  
Spinal Epidural

Objective To investigate the effect of the pre-administration with aminophylline on the occurrence of post-dural puncture headache (PDPH) in women undergoing caesarean section by combined spinal-epidural anaesthesia (CSEA). Methods The study enrolled women undergoing elective caesarean sections with CSEA and randomly allocated them into two groups; for 30 min immediately after the infant was delivered, group A received 250 mg aminophylline intravenously and group B received an equal volume of normal saline. Demographic data, operation time, intraoperative blood loss, intraoperative transfusion volume and the occurrence of PDPH during the first 7 days after the operation were recorded. Side-effects such as hypersensitivity, convulsion and arrhythmia were also recorded in the patients and infants in group A within 24 h after aminophylline administration. Results A total of 120 patients aged 24–38 years (pregnancy range, 38–42 weeks) were randomly allocated into two groups ( n = 60). The incidence of PDPH in group A was significantly lower than group C (two of 59 [3.4%] versus 10 of 58 [17.2%], respectively). There were no related side-effects within 24 h after aminophylline administration in group A. Conclusions Intraoperative intravenous infusion of 250 mg aminophylline reduced the incidence of PDPH after caesarean section under CSEA with no side-effects.

scholarly journals Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial

2013 ◽  
Vol 70 (6) ◽  
pp. 541-547 ◽  
Author(s):  
Zoran Slavkovic ◽  
Dusica Stamenkovic ◽  
Veselin Geric ◽  
Milic Veljovic ◽  
Nebojsa Ivanovic ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Epidural Catheter ◽  
Total Gastrectomy ◽  
Analgesic Effect ◽  
Catheter Removal ◽  
Anesthesia Induction ◽  
Double Blind Study ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Background/Aim. Combined spinal-epidural-general anesthesia has several advantages over general anesthesia alone. This study was designed to compare the efficacy of intrathecal (IT) morphine alone, or in combination with bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE) analgesia, in patients undergoing elective total gastrectomy. Methods. This prospective, randomized double-blind study included 60 patients undergoing total gastrectomy under general anesthesia and CSE. We compared the analgesic effect of lumbar IT morphine 300 ?g (the group M, n = 20) vs morphine 300 ?g + bupivacaine 2 mg (the group MB, n = 20) vs morphine 300 ?g + bupivacaine 2 mg + fentanyl 25 ?g (the group MBF, n = 20) given after thoracic epidural catheter placement (T6-7) but before general anesthesia induction. Pain visual analogue scale (VAS) at rest (R), with movement (M) and with cough (C), and the number of analgesia requests were assessed for 72 h and after epidural catheter removal. Results. Compared to other groups, the MBF group required significantly fewer additional intra-operative epidural bupivacaine doses (p < 0.001), whereas the M group required significantly more supplemental intraoperative intravenous fentanyl, compared with the MBF (p = 0.022) and MB groups (p = 0.005). Postoperative pain relief was satisfactory in all the groups at all the time. VAS-R and VAS-M did not differ significantly among the groups. Compared to the M group, VAS-C scores 30 min postoperatively were significantly lower in the MBF (p = 0.029) and MB groups (p = 0.002). Duration of analgesia was longer in the MBF and MB groups, but the difference reached no significance. The number of supplemental analgesia requests was similar in all the groups in the first 12 h and during 72 h. Additional analgesia requests after epidural catheter removal were similar in all the groups, and side effects were infrequent. Conclusion. Compared to IT morphine alone, triple IT combination administered as part of CSE provided better intraoperative analgesia, but conferred no benefit with regards to postoperative analgesia.

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