Serious Complications After Epidural Catheter Placement: Two Case Reports

Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.

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Patient anxiety scores after low-dose ketamine or fentanyl for epidural catheter placement

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03019675 ◽

2000 ◽

Vol 47 (9) ◽

pp. 910-913 ◽

Cited By ~ 11

Author(s):

Akiyoshi Oda ◽

Hiroki Iida ◽

Shuji Dohi

Keyword(s):

Epidural Catheter ◽

Low Dose ◽

Catheter Placement ◽

Patient Anxiety ◽

Epidural Catheter Placement

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Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate

Regional Anesthesia and Pain Medicine ◽

10.1097/aap.0000000000000637 ◽

2017 ◽

Vol 42 (5) ◽

pp. 649-651 ◽

Cited By ~ 10

Author(s):

Yehoshua Gleicher ◽

Oskar Singer ◽

Stephen Choi ◽

Paul McHardy

Keyword(s):

Epidural Catheter ◽

Operating Room ◽

Failure Rate ◽

Catheter Placement ◽

Operating Room Efficiency ◽

Epidural Catheter Placement ◽

Thoracic Epidural ◽

Thoracic Epidural Catheter ◽

Block Area

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Epidural stimulation test vs epidural ECG test for checking epidural catheter placement

British Journal of Anaesthesia ◽

10.1093/bja/aei613 ◽

2005 ◽

Vol 95 (6) ◽

pp. 837 ◽

Cited By ~ 3

Author(s):

B.C.H. Tsui

Keyword(s):

Epidural Catheter ◽

Catheter Placement ◽

Stimulation Test ◽

Epidural Stimulation ◽

Epidural Catheter Placement

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Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer a randomized trial

10.21203/rs.2.516/v3 ◽

2019 ◽

Author(s):

Lutz Kaufner ◽

Phil Niggemann ◽

Tobias Baum ◽

Sara Casu ◽

Jalid Sehouli ◽

...

Keyword(s):

Ovarian Cancer ◽

Epidural Catheter ◽

Core Temperature ◽

Cytoreductive Surgery ◽

Patient Flow ◽

Temperature Drop ◽

Subcutaneous Fat ◽

Catheter Placement ◽

Body Core Temperature ◽

Epidural Catheter Placement

Abstract Background: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. Methods: After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43°C during epidural catheter placement. BCT (Spot on®, 3M) was measured before (T1), after induction of GA (T2) at 15 min (T3) after start of surgery, and until 2h after ICU admission (TICU2h). Primary endpoint was BCTdrop between T1 and T2. Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. Results: BCTdrop was 0.35 °C with prewarming and 0.9 °C without prewarming (p< 0.005) and BCT remained higher over the observation period (ΔT4 = 0.9 °C up to ΔT7 = 0.95 °C, p<0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO2 were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p< 0.001). Conclusion: Prewarming at 43°C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. Trial registration: ClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015

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Patient-Controlled Epidural Analgesia/Continuous Epidural Catheters

10.2310/anes.15039 ◽

2016 ◽

Author(s):

Devin Peck

Keyword(s):

Epidural Catheter ◽

Local Anesthetics ◽

Catheter Placement ◽

Labor Pain ◽

Abdominal Incision ◽

Tumor Spread ◽

Epidural Catheter Placement ◽

Thoracic Epidural ◽

Cord Injury ◽

Epidural Catheters

Although useful for management of many types of pain, the most common indication for epidural catheter placement is for management of labor pain. High lumbar and thoracic epidural catheter placement has gained increasing popularity in recent years for the management of postoperative pain. The technique is most commonly employed for procedures in which a thoracic or an extensive abdominal incision is anticipated. Absolute contraindications for epidural catheter placement include patient refusal, uncorrected hypovolemia, increased intracranial pressure, local infection at the planned site of insertion, and patient allergy to amide/ester local anesthetics. Relative contraindications include coagulopathy, an uncooperative patient, severe anatomic abnormalities of the spine, sepsis, and hypertension. The advantages include attenuation of the sympathetic response to surgical stimulation and pain; effects on the cardiovascular, respiratory, and gastrointestinal systems; thromboprotective effects; and possibly limitation of tumor spread. The risks of epidural catheter placement include epidural hematoma, infection, nerve or spinal cord injury, dural puncture, or respiratory or cardiovascular depression from a high block. Epidural opioids provide analgesia without causing motor or sympathetic blockade. Epidurally administered local anesthetics may result in decreased postoperative ileus, nausea, vomiting, and sedation, which can be associated with opioids. Local anesthetics and opioids act additively or synergistically and, when used together, can lead to a reduction in the dose of each drug.

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