Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations

Abstract

Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic changes, it has been used for various surgeries. There have been no previously published systematic reviews aimed at assessing its clinical utility. This systematic review was performed to explore the perioperative benefits of CEA. The review was also aimed at identifying the rationale of its use, reported surgical indications and the method of use. We performed a literature search involving PubMed and Embase databases, to identify studies using CEA for surgical indications. Out of 467 potentially relevant articles, 73 articles were selected. Two independent investigators extracted data involving 5 randomized controlled trials, 17 observational comparative trials, and 51 case reports (series). The outcomes studied in most comparative studies were on effects of local anaesthetics and other agents, systemic effects, and feasibility of CEA. In one randomized controlled study, CEA was observed to decrease the resting pain scores after pharyngo-laryngeal surgeries. In a retrospective study, CEA was shown to decrease the cancer recurrence after pharyngeal-hypopharyngeal surgeries. The limited evidence, small studies, and the chosen outcomes do not allow for any specific recommendations based on the relative benefit or harm of CEA. Considering the potential for significant harm, in the face of better alternatives, its use must have a strong rationale mostly supported by unique patient and surgical demands. Future studies must aim to assess analgesic comparator effectiveness for clinically relevant outcomes.

Cervical Epidural Anaesthesia for Proximal Humerus Fracture Plating Surgery in a Patient With CKD Grade 5- A Case Report

“…In epidural anaesthesia, commonly higher concentrations (bupivacaine0.5% or lignocaine 2%) and higher volumes (up to 20-25mL) are used, but for CEAdiluted concentrations (bupivacaine0.25% or lignocaine 1%) and lower volumes are preferable, which benefitted us in this patient to prevent local anaesthetic-related drug toxicity and also motor blockade, which is a undesired effect of CEA, which may lead to respiratory muscle paresis requiring assisted ventilation. 5,6,7 Thus, CEA provided high quality surgical anaesthesia with minimal drugs and excellent postoperative analgesia for next 24 hours, 8 which avoided use of opioids and of course NSAIDS, which are contraindicated in our CKD patient. Other advantages were early ambulation, cost effectiveness and reduced incidence of postoperative morbidity such as respiratory complications and venous thromboembolism.…”

Continuous cervical epidural analgesia in metastatic spinal cord compression

“…[ 16 18 ] A recent review of literature that examined cervical epidural analgesia in overall practice remained equivocal on its role while highlighting the need for careful selection of cases for this intervention. [ 19 ]…”

Cervical Epidural Anesthesia for Treatment of Bilateral Humeral Fracture in Beach Chair Position. Case Report

“…[1] The ECA results from superficial cervical plexus block (C1-C4) and brachial plexus block (C5-T1/T2), being indicated for surgery, treatment of postoperative pain or chronic pain treatment. [1] The approach to the epidural space at the C7-T1 interspace is not technically difficult.…”

“…[1] The ECA results from superficial cervical plexus block (C1-C4) and brachial plexus block (C5-T1/T2), being indicated for surgery, treatment of postoperative pain or chronic pain treatment. [1] The approach to the epidural space at the C7-T1 interspace is not technically difficult. Patients are placed in the sitting position, increasing the negative pressure in the epidural space, with the head flexed on the thorax, in order to open the lowest cervical interspace.…”