An Analysis of the Radiological Visualization of the Catheters Placed in the Epidural Space

Sánchez, R; Acunã, Luis Ernesto Ballesteros; Rocha, Francisco Galindo

doi:10.1093/bja/39.6.485

Cited by 71 publications

(26 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sixteen of these were found to have emerged through the intervertebral foramina. Only half of these patients experienced paraesthesia during catheter insertion, Sanchez et al 3 performed a similar radiological study in 1967 with 90 catheters inserted to distances ranging from…”

Section: Discussionmentioning

confidence: 98%

Transforaminal escape of a lumbar epidural catheter

1992

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 98%

Transforaminal escape of a lumbar epidural catheter

1992

View full text Add to dashboard Cite

“…Lim et al (20) found that the catheter tip could be advanced without coiling for 4cm or less in only 13% of cases. Hogan (21) found that lateral catheter deviation is a more common cause of asymmetric block than anatomic barriers to the spread of the local anesthetic solution Using radiography, Sanchez et al (22) showed that the intended catheter placement was often not achieved. When epidural anesthesia is incomplete, additional injections or catheter manipulation may provide reliable surgical anesthesia, suggesting suboptimal positioning of the catheter.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Effects of Administration of Local Anaesthetics Through Epidural Needle Before and After Epidural Catheter Insertion

Ramtani¹,

Tarkase²,

Cham³

2015

jemds

View full text Add to dashboard Cite

Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesias, venous and subarachnoid cannulation, suboptimal catheter placement and coiling of catheter can affect the quality of anesthesia. A prospective randomized controlled study was conducted to assess the effect of priming of epidural space with a single-injection dose of local anesthetic solution (10mL 2% lidocaine+ adrenaline and 10ml 0.5% bupivacaine) before catheter insertion. We randomized 100 patients into 2 equal groups and measured the quality of anesthesia and incidence of catheter related complications. METHODS: A group of 100 patients was randomized and divided in two groups. In Group A [needle group] (n _ 50), local anaesthetic solution was administered through epidural needle before epidural catheter insertion. In Group B [catheter group] (n _ 50), the catheter was inserted immediately after identification of the epidural space. Local anesthetic solution was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement, number of attempts to insert catheter. Sensory and motor block were assessed 20 min after the injection of local anesthetic solution. Surgery was initiated when adequate sensory loss was confirmed. Infraumbilical, pelvic general surgeries, hysterectomies and lower limb orthopedic surgeries were included in study. RESULTS: All observations were noted and statistical test of significance was applied. In the catheter group, the incidence of paresthesia during catheter placement was 16% compared with 4% in the needle group (x 2 =4.0, P<0.05). Intravascular catheter placement occurred in 8% versus 0% of patients in the catheter and needle groups, respectively (x 2 = 5.34, P<0.05). The number of attempts to pass catheter was more than one in catheter group as compared to needle group. (x 2 =4.33, P<0.05) More patients in the needle group had excellent quality of surgical conditions than the catheter group (94% versus 35%) (x 2 =9.75, P<0.05). CONCLUSION: We conclude that priming of epidural space with a single injection local anaesthetic dose via the epidural needle before catheter placement improves the quality of anesthetic blockade and reduces catheter-related complications.

show abstract

“…The coiling length was similar irrespective of the cephalad (1-5.5 cm) or caudal direction (1.5-8 cm) of the needle. Bends were noted on the removed catheters, suggesting that after being advanced a short distance into the epidural space, the catheters became coiled within the epidural space [12,15,16]. A catheter bends when the tip confronts the dura mater, blood vessels, connective tissue, and neural structures that may hinder its advancement [4].…”

Section: Discussionmentioning

confidence: 99%

“…A correlation between what is felt and what is observed can assist in gauging the behavior of a catheter when it is inserted at different lengths inside the epidural space. Investigators have used radiological methods to study the behavior of a catheter inside the epidural space, but it is not feasible to use such methods to determine the point of intravascular placement [12]. This study was designed to investigate where the resistance was felt during the advancing of a catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration.…”

Section: Introductionmentioning

confidence: 99%