scholarly journals Case Report: Pneumocephalus after labor epidural anesthesia

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 166 ◽  
Author(s):  
Beatriz Nistal-Nuño ◽  
Manuel Ángel Gómez-Ríos
Keyword(s):  
Epidural Space ◽  
Epidural Anesthesia ◽  
Dural Puncture ◽  
Epidural Injection ◽  
Symptomatic Treatment ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
Lumbar Epidural Anesthesia ◽  
Labor Epidural ◽  
The Brain

Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications.

scholarly journals Pneumocephalus After Dural Puncture During Epidural Analgesia: A Case Report

2019 ◽  
Vol 7 (1) ◽  
pp. 52-53
Author(s):  
Gholamreza Mohseni ◽  
Faranak Behnaz ◽  
Zahra Tahmasebi
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Epidural Analgesia ◽  
Epidural Anesthesia ◽  
Dural Puncture ◽  
Loss Of Consciousness ◽  
Loss Of Resistance ◽  
Lumbar Epidural Anesthesia ◽  
Post Operation ◽  
Control Post

Lumbar epidural anesthesia commonly used to control post-operation pain. The ‘loss-ofresistance’ to air technique (LORA) generally engaged in the appreciation of the epidural space. One of the rare but serious side effects of this technique is pneumocephalus. We report a case of sudden frontal and parietal headache after a dural puncture during the performance of epidural analgesia using the LOR to air technique. Keywords: Epidural analgesia; ‘loss-of- resistance’ to air technique (LORA); Pneumocephalus; loss of consciousness; headache.

scholarly journals False Loss of Resistance in Cervical Epidural Injection: The Loss of Resistance Technique Compared with the Epidrum Guidance in Locating Epidural Space

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 131-138
Author(s):  
Dr. Woo Seog Sim
Keyword(s):  
Epidural Space ◽  
Medical Center ◽  
Academic Medical Center ◽  
False Negative ◽  
Epidural Injection ◽  
Epidural Block ◽  
Epidural Injections ◽  
Academic Medical ◽  
Combined Use ◽  
Loss Of Resistance

Background: Epidural block failures can occur due to a misleading loss of resistance (LOR) signal. Objective: This study was designed to evaluate the false LOR rate and to determine whether the Epidrum, which is an LOR device for identifying the epidural space, improves the ability to find the epidural space during cervical epidural injection compared the LOR technique. Study Design: A randomized, single-blind trial. Setting: Single academic medical center. Methods: A total of 150 patients undergoing cervical interlaminar epidural injections at C7-T1 were randomized to receive either the LOR technique with a syringe (group C) or the Epidrum guidance (group E). Fluoroscopic images were used to confirm the accuracy of the needle placement within the epidural space. The rate of misleading epidural signals and adverse effects were recorded and analyzed. Results: The false LOR rate was 74.7% for group C, 62.7% for group E, and 68.7% overall. The incidence of false LOR was not significantly different between the 2 groups. Also, the success rate and the rate of true epidural signals were similar between the 2 groups. Limitations: The Epidrum cannot be used to confirm whether the needle has entered the vascular space without fluoroscopy. Conclusions: In this study, we did not find any difference in accuracy between the Epidrum and the LOR technique with a syringe for detecting the cervical epidural space. The overall higher false LOR rate suggests that the combined use of fluoroscopy and LOR technique with a syringe or the Epidrum is necessary to increase the rate of finding the true cervical epidural space. Clinical Trials registration: KCT0001333 Key words: Cervical epidural injection, epidural space, Epidrum, false positive, false negative, loss of resistance

scholarly journals Feasibility of Using the Epidural Space Detecting Device (EPI-DetectionTM) for Interlaminar Cervical Epidural Injection

2020 ◽  
Vol 9 (8) ◽  
pp. 2355
Author(s):  
Jiin Kang ◽  
Sam Sun Park ◽  
Chul Hwan Kim ◽  
Eui Chul Kim ◽  
Hyung Cheol Kim ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Epidural Space ◽  
Negative Pressure ◽  
Operation Time ◽  
Epidural Injection ◽  
Cervical Radiculopathy ◽  
Loss Of Resistance ◽  
Operative Complications ◽  
Post Operative Complications

Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-DetectionTM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-DetectionTM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-DetectionTM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm2 vs. 380.3 ± 340.9 mGy·cm2, respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-DetectionTM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-DetectionTM may help perform ILCEI safely.

scholarly journals Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Kosturakis ◽  
Jose Soliz ◽  
Jackson Su ◽  
Juan P. Cata ◽  
Lei Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Depth Measurement ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

scholarly journals Differentiating False Loss of Resistance from True Loss of Resistance While Performing the Epidural Block with the CompuFlo® Epidural Instrument

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Pasquale Vaira ◽  
Michela Camorcia ◽  
Tiziana Palladino ◽  
Matteo Velardo ◽  
Giorgio Capogna
Keyword(s):  
Epidural Space ◽  
Epidural Block ◽  
Epidural Needle ◽  
Predictive Values ◽  
Specificity And Sensitivity ◽  
Loss Of Resistance ◽  
Accidental Dural Puncture ◽  
Sudden Decrease ◽  
Sensitivity Specificity ◽  
Labor Epidural

Background. The occurrence of false losses of resistance may be one of the reasons for inadequate or failed epidural block. A CompuFlo® epidural instrument has been introduced to measure the pressure of human tissues in real time at the orifice of a needle and has been used as a tool to identify the epidural space. The aim of this study was to investigate the sensitivity and the specificity of the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance encountered during the epidural space identification procedure. Method. We performed epidural block with the CompuFlo® epidural instrument in 120 healthy women who requested labor epidural analgesia. The epidural needle was considered to have reached the epidural space when an increase in pressure (accompanied by an increase in the pitch of the audible tone) was followed by a sudden and sustained drop in pressure for more than 5 seconds accompanied by a sudden decrease in the pitch of the audible tone, resulting in the formation of a low and stable pressure plateau. We evaluate the sensitivity, specificity, and positive and negative predictive values of the ability of CompuFlo® recordings to correctly identify the true LOR from the false LOR. Results. The drop in pressure associated with the epidural space identification was significantly greater than that recorded after the false loss of resistance (73% vs 33%) (P=0.000001). The sensitivity was 0.83, and the AUC was 0.82. Discussion. We have confirmed the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance and established its specificity and sensitivity. Conclusion. An easier identification of dubious losses of resistance during the epidural procedure is essential to reduce the number of epidural attempts and/or needle reinsertions with the potential of a reduced risk of accidental dural puncture especially in difficult cases or when the procedure is performed by trainees.

scholarly journals Pneumocephalus following fluoroscopy-guided lumbar epidural injection in elderly patients: two cases report and a review of Korean literatures - Two cases report -

2020 ◽  
Vol 15 (4) ◽  
pp. 492-497
Author(s):  
Sun Kyung Park ◽  
Sang Hyun Park ◽  
Bang Won Lee ◽  
Woo Jin Cho ◽  
Yun Suk Choi
Keyword(s):  
Elderly Patients ◽  
Pain Control ◽  
Older Patients ◽  
Dural Puncture ◽  
Epidural Injection ◽  
Epidural Block ◽  
Contrast Injection ◽  
Anatomical Changes ◽  
Loss Of Resistance ◽  
Accidental Dural Puncture

Background: Pneumocephalus can originate from accidental dural puncture while performing epidural block using the loss-of-resistance (LOR) technique with an air-filled syringe. Case: We present two cases of pneumocephalus after lumbar epidural block under fluoroscopy for pain control in elderly patients. Conclusions: Lumbar epidural block should be performed under fluoroscopic guidance in elderly patients with severe lesions. The physician should be aware of the increased possibility of a dural puncture occurring due to anatomical changes in older patients. The use of saline is recommended for the LOR technique. A contrast injection should be used together with the LOR technique to locate the epidural space. If a dural puncture occur, the patient should be carefully monitored to determine whether pneumocephalus has developed.

scholarly journals Lumbar Epidural space depth has better relations to the Weight than Height of the Patient

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Khalid Javed ◽  
Ambrin Amjad ◽  
Muhammad Aziz ◽  
Abdul Qayyum
Keyword(s):  
Lumbar Puncture ◽  
Epidural Space ◽  
Epidural Anesthesia ◽  
Epidural Anaesthesia ◽  
Tuohy Needle ◽  
Single Shot ◽  
Lumbar Epidural Anesthesia ◽  
Lumbar Epidural Anaesthesia ◽  
Male Patients

This study was carried out on one hundred and fifty male patients undergoing TURP and Cystoscopy under lumbar epidural anaesthesia in urology department mayo hospital with age between 30 years to 100 years with mean 64.29 years, weight 37kg to 96kg with mean 59.21kg and height between 140cm to 187cm with mean 165.34cm. All patients were administered single shot-lumbar epidural anesthesia with tuohy needle no 16 with bupivacain 0.5% volume ranging 15cc to 20cc at level of L3-4 or L4-5 level. Two patients developed lumbar puncture and managed conservatively. The lumbar epidural space ranged between 3.5cm to 6.5cm with mean depth 4.38±0.563. It was concluded statistically that lumbar epidural space depth had better relation to the weight of patients than height.

scholarly journals The Development of a Novel Device Based on Loss of Guidewire Resistance to Identify Epidural Space in a Porcine Model

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jaeyoung Yang ◽  
Rakmin Choi ◽  
Kyubum Cho ◽  
Seonjin Kim ◽  
Bousung Lee ◽  
...  
Keyword(s):  
3D Printing ◽  
Epidural Space ◽  
Dural Puncture ◽  
Porcine Model ◽  
Guide Wire ◽  
Prototype Model ◽  
Novel Device ◽  
Loss Of Resistance ◽  
Biocompatibility Test ◽  
Wire Resistance

Background. The application of additive manufacturing (3D printing) has been recently expanded to various medical fields. The new technique named loss of guide wire resistance (LOGR) was developed via 3D printing for the detection of epidural space using a guide wire instead of air or saline used in the loss of resistance (LOR) technique. Methods. The prototype model of epidural space finder consists of a polyactic acid (PLA) or a resin. It was manufactured with 3D printing. Biocompatibility test (eluate and sterility tests) was performed in both products. The advantage of the newly developed device was compared with conventional loss of resistance (LOR) technique in a porcine model. Results. Eluate and sterility tests revealed that the PLA was more biocompatible than the resin. The LOGR technique facilitated rapid access to epidural space compared with the LOR technique (41.64 ± 32.18 vs. 92.28 ± 61.46 seconds, N = 14, p=0.0102, paired sample t-test), without any differences in success rate (87.5%). Conclusion. We conclude that LOGR technique is comparable to LOR technique to access the epidural space, although the advantage of either technique in terms of complications such as dural puncture or epidural hematoma is unknown. We demonstrated the potential benefit of 3D printer for the development of a new medical device for anesthesia.

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