Caudal epidural blockades for chronic pain in the lower back in working age

Introduction. Chronic back pain syndrome, which significantly restricts a person’s daily activity, can cause the formation of depressive states and is a significantly more difficult task for treatment compared to acute pain.Aim. To evaluate the efficacy and safety of caudal epidural catheterization (CEC) and local therapy with anesthetics and glucocorticoids for chronic nonspecific discogenic and chronic radicular low back pain (LBP) in young and middle-aged patients.Materials and methods. 42 patients aged from 29 to 59 years, who in the neurosurgical department of the Vologda City Hospital No. 1 in 2017–2019 underwent an operation to install a caudal epidural catheter and prolonged injection therapy of local anesthetics and glucocorticosteroids for chronic nonspecific discogenic and chronic radicular LBP.Results. There were no purulent-septic complications, hematomas of the spinal canal. In the group of patients with radicular syndrome the average values of LBP according to VAS were as follows: before CEC – 78.5 mm; 5 days after CEC – 24.1 mm; 6 months after CEC – 19.6 mm; after 12 months – 17.9 mm. In the group of patients with nonspecific discogenic LBP the average pain estimates for VAS were as follows: before CEC – 78.1 mm; 5 days after CEC – 21.7 mm; 6 months after CEC – 20.9 mm; after 12 months – 23.4 mm.Сonclusion. Our experience indicates a high long-term efficacy and safety of treatment with caudal epidural catheterization and local prolonged therapy with anesthetics and glucocorticoids for chronic radicular and chronic nonspecific discogenic pain in the lower back in young and middle-aged patients selected on the basis of a special system of criteria.

A CASE OF PHYLLODES TUMOUR DONE UNDER CONTINOUS THORACIC EPIDURALANAESTHESIA IN A SIX MONTHS PREGNANT FEMALE

Phyllodes tumor is a rare neoplasm of female breast have its origin from the broepithelial cells of breast. It predominantly occur in females (0.3- 0.5%). Phyllodes in pregnancy are larger in size and rapidly growing may be because of the inuence of pregnancy hormones on the female breast tissues. A 22 year old female with six months of pregnancy with phyllodes tumor of right breast was posted for wide local excision and reconstruction of defect using latissimus dorsi myocutaneous ap. She had presented with swelling of approximately 24cm X10cm X 6cm in her right breast which developed pain since last eight days. She was maintained on the intravenous injection duvadilan (isoxsuprine) 80 mg 8 hourly for three days perioperatively for tocolysis. The case was done using thoracic epidural catheterization at T6-T7 interspace using 0.75% ropivacaine with no perioperative complications. The choice of anesthetic technique for the emergency procedures in pregnancy will depend on the trimester and the type and duration of surgical procedure. Whenever possible, a regional anesthetic technique should be used.

Epidural blockade in thoracic surgery: a case report

This report presents a clinical case of the treatment of pain syndrome in isolated chest trauma following an accident of a patient with liver cirrhosis and hypocoagulation syndrome who sustained bilateral fracture of the ribs (II, III, IV, V, and VI ribs on the right and II, III, IV, V, and VI ribs on the left), fracture of the sternum body in the middle third, bilateral hemopneumothorax, and contusion of both lungs. From the initial hours, fentanyl, which was administered intravenously in a complex of multimodal analgesia, was used for anesthesia. However, adequate pain control was not achieved. Against the background of pain syndrome, the patient developed impaired consciousness and respiratory failure. Epidural puncture and catheterization with an epidural injection of ropivacaine were performed, which relieved the pain syndrome and helped prevent pulmonary complications. The present case highlights the need for an individual assessment of the riskbenefit ratio of the use of epidural catheterization in patients with coagulopathy. Conclusion: The use of epidural analgesia for chest trauma in patients with moderate coagulopathy made it possible to initiate effective analgesia and reduce the risk of respiratory complications, which ultimately ensured a favorable outcome of severe trauma.

A new technique of epidural and intrathecal catheterization to evaluate pharmacokinetics of epidural administration in dogs: a prospective study

Background: Experimental research on animals should be performed before applying new treatment modalities in humans. Among experimental animal models, canine model research is a commonly used method. Injecting drugs into the epidural has also been commonly used in the canine animal model. In canine models, epidural catheters are often inserted into the lumbosacral area during epidural drug injection. Unlike the existing canine model, we describe a new and alternative technique of epidural and intrathecal catheterization to investigate methods of epidural drug administration in dogs. Methods: Twelve adult dogs were used in this study. The epidural procedures were performed with dogs in sternal recumbency under deep sedation. Epidural catheterization was perforemed at the T1-T2 intervertebral space with C-arm fluoroscopy guidance. After confirming the loss of resistance, a flexible epidural catheter was passed cranially to the C2-C3 level. The intrathecal procedures were performed with dogs in lateral recumbency under deep sedation. Intrathecal catheterization was performed through the cisterna magna with the neck slightly flexed. An 18-gauge Tuohy needle was inserted into the subarachnoid space through the atlanto-occipital space. After confirming cerebrospinal fluid leakage without bleeding, a flexible intrathecal catheter was passed caudally to the C2-C3 level. Results: All epidural and intrathecal catheterizations were successfully performed under deep sedation without any complications. Conclusion: The new technique of epidural and intrathecal catheterization in canines is an alternative procedure for investigating epidurally administered drugs.

A new technique of epidural and intrathecal catheterization to evaluate pharmacokinetics of epidural administration in dogs: a prospective study

Background: Compared to the conventional oral or intravenous drug administration, epidural administration of drugs has significantly higher efficacy and safety. Experimental research on animals should be performed before applying to humans. Unlike the existing canine model, we describe a new and alternative technique of epidural and intrathecal catheterization to investigate the efficacy and safety of epidural drug administration in dogs. Methods: Twelve adult dogs were used in this study. The procedures were performed with dogs in sternal recumbency under deep sedation. Epidural catheterization was performed at the T1–T2 intervertebral space with C-arm fluoroscopy guidance. After confirming loss of resistance, a flexible epidural catheter was passed cranially to the C2–C3 level. Intrathecal catheterization was performed through the cisterna magna with the neck slightly flexed. An 18-gauge Tuohy needle was inserted into the subarachnoid space through the atlanto-occipital space. After confirming cerebrospinal fluid leakage without bleeding, a flexible intrathecal catheter was passed caudally to the C2–C3 level. Results: All epidural and intrathecal catheterizations were successfully performed under deep sedation without any complications. Conclusion: The new technique of epidural and intrathecal catheterization in canines is a safe and alternative procedure for investigating the toxicity and pharmacology of epidurally administered drugs.