epidural catheter placement
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2021 ◽  
Vol 8 ◽  
Author(s):  
Amanda R. Watkins ◽  
Klaus Hopster ◽  
David Levine ◽  
Samuel D. Hurcombe

A 20-year-old Quarter Horse gelding was presented with severe right forelimb lameness (5/5 AAEP Lameness Scale) due to a tear of the superficial digital flexor muscle which was diagnosed via palpation of swelling and ultrasonography revealing major muscle fiber disruption and hematoma formation. When traditional systemic therapy (non-Steroidal anti-inflammatories) did not restore clinically acceptable comfort and the risk of supporting limb laminitis became a reasonable concern, a cervical epidural catheter was placed between the first and second cervical vertebrae in the standing, sedated patient using ultrasound guidance. The gelding was treated with epidural morphine (0.1 mg/kg every 24 h then decreased to 0.05 mg/kg every 12 h) and was pain-scored serially following treatment. Spinal analgesia was provided for 3 days. Pain scores significantly decreased following each treatment with morphine, and the gelding was successfully managed through the acutely painful period without any adverse effects associated with the C1-C2 epidural catheter placement technique, the epidural morphine, or contralateral limb laminitis. At the 2-month follow-up, the gelding was walking sound with no complications seen at the catheter insertion site. In this case, spinal analgesia using epidural morphine administered via a cervical epidural catheter was an effective and technically achievable option for pain management associated with severe forelimb muscle injury in a horse.


2021 ◽  
Vol 14 (9) ◽  
pp. e242622
Author(s):  
Katherine Jane Chua ◽  
Maureen Cernadas

Horner’s syndrome is a rare side effect for patients receiving epidural anaesthesia. Studies described Horner’s syndrome due to cephalic spread of injected anaesthetics, a high spinal anaesthesia, or a sign of an inadvertent subdural block. A 31-year-old woman (Gravida 1 Para 0) at 40 weeks and 2 days had a caesarean section secondary to second stage arrest. Fourteen minutes after she received the lidocaine bolus, she became unresponsive with nystagmus, unequal pupils and no pupillary reflex. Head CT and MRI showed no intracranial haemorrhage and 2 hours later, she had spontaneous resolution of neurological symptoms with no further sequelae. Although Horner’s syndrome is a benign, transient process, clinicians should be mindful regarding epidural catheter placement causing subdural blocks resulting in spontaneous, reversible neurological deficits.


2021 ◽  
pp. 62-64
Author(s):  
Ravi Anand ◽  
Preeti Kumari ◽  
Sanjeev Kumar ◽  
Siddharth Singh ◽  
Ganesh Kumar Ram

Background And Aims: Epidural anaesthesia is widely performed using a landmark-guided midline approach. The indistinct or distorted landmark is associated with obesity, previous spinal surgeries, deformities, or degenerative changes due to ageing. In the present study, we compared the efcacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients. Methods: Sixty patients with body mass index (BMI) >30 kg/m2 were included in the study. The participants were randomly assigned to two groups : PUS and RUS group . The primary end point was to attain a successful placement of epidural catheter. Variables like the number of attempts, the number of passes, the time taken for identifying epidural space(s), and time taken for successful epidural catheter placement(s) were secondary end points and were recorded in both the groups. Results: The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value < 0.001). The median number of passes, the median time for identifying space, and the time for successful epidural catheter placement was statistically signicantly less in the RUS group, than the PUS group. Conclusion:The time taken for the identication of the space, the number of attempts, number of passes, and the time taken for successful epidural catheter placement was more in the PUS group as compared to the RUS group.


Author(s):  
Jong-Hyuk Lee ◽  
Doo-Hwan Kim ◽  
Won Uk Koh

Thoracic epidural analgesia (TEA) is known to have superior perioperative pain control over intravenous (IV) opioid analgesia in open abdominal surgery and is an essential enhanced recovery after surgery (ERAS) component in major abdominal surgeries. Recently, the ultrasound-guided thoracic epidural catheter placement (TECP) technique has drawn attention as an alternative for the traditional landmark palpation-based TECP or fluoroscopic-guided TECP technique due to the equipment’s improvement and increased popularity. However, only a small number of studies have introduced the advantages and usefulness of ultrasound-guided TECP. Moreover, a certain level of ultrasound-guided in-plane technique is required to perform this technique. Thus, to apply ultrasound-guided TECP correctly and reduce the likelihood of side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, device selection, and management. In this technical review, the authors have compared the advantages and disadvantages of ultrasound-guided TECP to traditional techniques and described its technical aspects from patient positioning, ultrasound probe selection and scanning, needle insertion under ultrasound guidance, and successful thoracic epidural catheter insertion confirmation through ultrasound imaging. Additionally, the recommended epidural catheter tip placement level with the extent of its injectate epidural spread is further described in this review in reference to a recent prospective study published by the authors.


2021 ◽  
Vol Volume 14 ◽  
pp. 117-124
Author(s):  
Ronald Seidel ◽  
Marc Tietke ◽  
Oliver Heese ◽  
Uwe Walter

2021 ◽  
Author(s):  
Sean Wayne Dobson ◽  
Robert Stephen Weller ◽  
Christopher Edwards ◽  
James David Turner ◽  
Jonathan Douglas Jaffe ◽  
...  

Abstract Background: Loss of resistance (LOR) for epidural catheter placement has been utilized for almost a century. LOR is a subjective endpoint associated with a high failure rate. Nerve stimulation (NS) has been described as an objective method for confirming placement of an epidural catheter. We hypothesized that the addition of NS to LOR would improve the success of epidural catheter placement.Methods: One-hundred patients were randomized to thoracic epidural analgesia (TEA) utilizing LOR-alone or loss of resistance plus nerve stimulation (LOR+NS). The primary endpoint was rate of success, defined as loss of sensation following test dose. Secondary endpoints included performance time. An intention-to-treat analysis was planned, but a per-protocol analysis was performed to investigate the success rate when stimulation was achieved.Results: In the intention-to-treat analysis there was no difference in success rates (90% vs 82% [LOR+NS vs LOR-alone]; P = 0.39). The procedural time increased in the LOR+NS group (33.9 ± 12.8 vs 24.0 ± 8.0 min; P < 0.001). The per-protocol analysis found a statistically higher success rate for the LOR+NS group compared to the LOR-alone group (98% vs. 82%; P = 0.017) when only patients in whom stimulation was achieved were included.Conclusions: Addition of NS technique did not statistically improve the success rate for epidural placement when analyzed in an intention-to-treat format and was associated with a longer procedural time. In a per-protocol analysis a statistically higher success rate for patients in whom stimulation was obtained highlights the potential benefit of adding NS to LOR.Trial registration: ClinicalTrials.gov identifier NCT03087604 on 3/22/2017; Institutional Review Board Wake Forest School of Medicine IRB00039522, Food and Drug Administration Investigational Device Exemption: G160273.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Toshiyuki Mizota ◽  
Kayo Kimura ◽  
Chikashi Takeda

Abstract Background Although most epidural catheter knot formation has been reported in lumbar epidural catheter placement, knot formation in a thoracic epidural catheter has been experienced. Case presentation A 72-year-old woman was scheduled for laparoscopic cholecystectomy under general anesthesia combined with epidural anesthesia. The epidural catheter was inserted through the Th10–Th11 intervertebral space and was placed 7 cm into the epidural space. Two days after the surgery, the anesthesiologist was called because of difficulty in removing the epidural catheter. The catheter was eventually removed when the anesthesiologist carefully pulled it while strongly bending the patient’s body to the right, although resistance was still noted. The removed catheter was observed to have a hard single knot formed at about 3 mm from the tip. Conclusions A knot formation of an epidural catheter placed at the thoracic level was experienced. Limiting the length of catheter placement may prevent knot formation.


2021 ◽  
Vol Volume 14 ◽  
pp. 103-108
Author(s):  
Alessandra Coccoluto ◽  
Giorgio Capogna ◽  
Michela Camorcia ◽  
Mark Hochman ◽  
Matteo Velardo

2021 ◽  
Vol 7 (2) ◽  
pp. 01-04
Author(s):  
Jonathan Rawley

A 72 year old man presented for colostomy repair prompting epidural catheter placement for pain management. A prolonged activated partial thromboplastin time (aPTT) coupled with degenerative spine disease were noted prior to placement. Postoperatively, he developed shortness of breath and leg weakness. This impelled a computed tomography (CT) scan for pulmonary embolism (PE) evaluation, which revealed an epidural hematoma. Stable neurologic findings prompted conservative management. In conclusion, 1) prolongation in aPTT should prompt consideration before neuraxial procedures, 2) vitamin K deficiency is a risk factor for epidural hematoma, and 3) hematoma management should be dictated by progression of neurologic findings.


2021 ◽  
pp. rapm-2021-102578
Author(s):  
Doo-Hwan Kim ◽  
Jong-Hyuk Lee ◽  
Ji Hoon Sim ◽  
Wonyeong Jeong ◽  
Dokyeong Lee ◽  
...  

Background and objectiveThoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement.Methods38 patients in the prone position were prospectively studied. After the target interlaminar space between T9 and T12 was identified, the needle was advanced under real-time US guidance and was stopped just short of the posterior complex. Further advancement of the needle was accomplished without US guidance using loss-of-resistance techniques to normal saline until the epidural space was accessed. Procedure-related variables such as time to mark space, needling time, number of needle passes, number of skin punctures, and the first-pass success rate were measured. The primary outcome was the success rate of real-time US-guided thoracic epidural catheter placement, which was evaluated using fluoroscopy. In addition, the position of the catheter, contrast dispersion, and complications were evaluated.ResultsThis study included 38 patients. The T10–T11 interlaminar space was the most location for epidural access. During the procedure, the mean time for marking the overlying skin for the procedure was 49.5±13.8 s and the median needling time was 49 s. The median number of needle passes was 1.0 (1.0–1.0). All patients underwent one skin puncture for the procedure. The first-pass and second-pass success rates were 76.3% and 18.4%, respectively. Fluoroscopic evaluation revealed that the catheter tips were all positioned in the epidural space and were usually located between T9 and T10 (84.2%). The cranial and caudal contrast dispersion were observed up to 5.4±1.6 and 2.6±1.0 vertebral body levels, respectively. No procedure-related complications occurred.ConclusionReal-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.Trial registration numberNCT03890640.


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