Effects of Epidural Needle Rotation and Different Speeds of Injection on the Distribution of Epidural Block

Şen, Özlem; Donmez, N.F.; Ornek, Dilsen; Kalaycı, Dilek; Arslan, Mahmut; Dikmen, Bayazıt

doi:10.1016/s0034-7094(12)70185-x

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…It can however be used intentionally to provide analgesia selectively to the limb being operated. This can be achieved through rotating of the introducing Tuohy epidural needle to direct the local analgesic solution to the required side to produce an intended unilateral epidural block [15, 17]. Producing a preferential distribution of the epidural block toward the operative side may have potential advantages in patients undergoing unilateral surgery on the lower limb.…”

Section: Discussionmentioning

confidence: 99%

“…The distribution of an epidural block cannot be controlled by gravity or patient position. Nonetheless, obtaining a preferential distribution of the epidural block towards the operative side is useful, especially when large doses of analgesics are required postoperatively to tolerate aggressive physiotherapy [15]. By evaluating the epidural catheter tip position and distribution of the injected solution by computed tomography (CT), Hogan clearly demonstrated that most epidural catheter tips are placed in an anterior or lateral position.…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that introducing the needle tip is positioned at an angle from the midline towards the patient's pathologic side, an effective drug spread to the target area is expected since most of the injected local anesthetic will spread to the surgical side and various reports have supported the clinical efficacy of such an intentional ‘unilateral epidural block’ [15, 16].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients’ Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial

Hosseini¹,

Mosaffa²,

Dabir³

et al. 2019

BEAT

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Objective: To evaluate the evolution pattern of epidural block after rotating the needle tip 45° to the operative side and evaluate its effects on patients’ hemodynamics and recovery profile in those undergoing arthroscopic knee surgery. Methods: Forty participants were randomly subdivided into control and rotation group (n=20). An 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L4-5 and pushed forward into the epidural space through parasagittal approach, in control group, the needle was pushed forward to the epidural space in cephaldad 90 degrees. For the rotation group, the needle was pushed forward to the epidural space and the tip was rotated 45 degrees to the surgical side.15 mL of bupivacaine 0.5% was injected and evolution of sensory and motor blocks until 2-segment regression of the sensory level below to T10 as well as total duration of motor block and surgery were recorded. Hemodynamic parameters (HR, MAP, and SPO2), hypotension, fluid intake, vasopressors, first ambulation and spontaneous urination were recorded. Statistical analysis was performed using SPSS and P≤0.5 considered significant. Results: S ensory block up to T10 level, Complete motor block and time for 2-segment regression of sensory level were earlier in the 45°-rotation than in the control group ( p <0.001). Total duration of motor block in control group was lower than rotation group ( p <0.001).Hypotension, N&V, vasopressors and fluid intake showed no statistically difference between the two groups ( p =0.219). First spontaneous urination and ambulation were significantly lower in rotation group ( p <0.001). Conclusion: 45 degrees’ needle rotation to the surgical side provides a faster block evolution and hastened recovery profile with no significant difference in hemodynamic fluctuations. Clinical trial registry: IRCT20130518013364N7

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients’ Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial

Hosseini¹,

Mosaffa²,

Dabir³

et al. 2019

BEAT

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“…Two studies investigating intentional rotation of epidural needles have found this to be an effective technique in targeting specific sides for analgesia/anesthesia. This suggests that needle orientation and rotation can contribute to unilateral blocks and may be important in avoiding these blocks [9,10]. erated a hypothesis for future studies (with some outstanding concerns regarding safety and effectiveness), it is unlikely to be adopted as the standard of care under current conditions.…”

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confidence: 99%

Unilateral Epidural Block: A Persistent Problem with No Good Solution

Hu¹,

B²

2018

Transl Perioper & Pain Med

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Finally, imaging-guided epidural catheter placement has been routinely used to provide bilateral analgesia, with high success rates, in chronic pain management, suggesting increasing rates of centrally-placed catheters may decrease the incidence of unilateral block [11].However, Zhang's approach raises three interesting questions: 1) Can all individuals feel their epidural catheter insertion and appreciate its laterality? 2) Is it a good idea to redirect catheters by rotating the needles and potentially "core out" the dura, or to repeatedly insert and withdraw the epidural catheter from the end of the epidural needle, with the risk of potentially shearing or otherwise damaging the catheter [9]? and 3) While this technique may increase likelihood of midline catheter placement initially, how often does subsequent catheter migration within the epidural space ultimately lead to a unilateral block?Moreover, another study investigated 11 parturients with unilateral epidural analgesia and their epidurogram findings suggested at least three other explanations: 1) 5 cases with midline anatomical barriers, 2) 2 cases with spinal deformity, and 3) 4 cases with catheter malfunction [12]. Bolusing of local anesthetic was more effective than catheter manipulation at resolving unilateral block [13], and the use of programmed intermittent epidural bolus, rather than continuous epidural infusion, for maintenance of labor analgesia decreased the incidence of unilateral block 3-fold [14]. Interestingly, the incidence of right-sided block was approximately 4.2 times greater than the incidence of left sided-block [13]; this could potentially be attributable to preferential use of left uterine displacement of laboring women with patient-controlled epidural analgesia or continuous epidural infusion. Studies have also revealed that a previous history of unilateral block is a risk factor for the development of subsequent unilateral block, suggesting that that anatomic variations such as epidural septae may significantly contribute to this phenomenon [15]. In the other words, Dr. Zhang's method may not solve unilateral block issue completely.In conclusion, while Dr. Zhang's approach has genUnilateral epidural analgesia is a common and persistent issue of incomplete analgesia. This phenomenon of one-sided epidural catheter placement was first described in 1967 through radiographic analysis [1], and examples of unilateral epidural analgesia continue to exist a half century later.Clinically, it is important to better understand how to troubleshoot and even avoid unilateral analgesia in daily practice. This is especially important when stat cesarean delivery is involved. In 2015, Yeager, et al. showed that unilateral epidural catheter placement is associated with complicated postoperative courses [2]. To this end, efforts have been made to decrease the incidence of inadequate epidural block. These efforts include: improved epidural catheter design [3], comparing the use of saline versus air to find loss of resistance when placing catheters [...

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Dispersão da lidocaína administrada por via epidural em cães posicionados em decúbito lateral ou esternal

Boff

Macarini

Marco

et al. 2020

Arq. Bras. Med. Vet. Zootec.

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RESUMO O objetivo do estudo foi verificar clinicamente a dispersão da lidocaína no espaço epidural de cães posicionados em diferentes decúbitos. Foram utilizados 16 cães, com peso médio de 17,5 quilogramas. Esses foram tranquilizados com acepromazina, anestesiados com propofol e alocados em dois grupos, conforme o decúbito de posicionamento: decúbito esternal (GE) e decúbito lateral direito (GLD). Ambos os grupos receberam lidocaína a 2%, no volume de 0,25mL/kg, e permaneceram no mesmo decúbito por 20 minutos. Em seguida, avaliou-se o bloqueio dos membros pélvicos e a extensão do bloqueio, a partir da sétima vértebra lombar, por meio de pinçamento interdigital e do panículo paravertebral. Foi, então, realizada cirurgia de orquiectomia. Após tal procedimento, avaliou-se o tempo total de bloqueio dos membros pélvicos. Todos os cães apresentaram bloqueio bilateral, sem diferenças quanto à extensão cranial entre os grupos, sendo a mediana de 7,5 (1-14) vértebras para GE e de 4 (1-14) para GLD. O tempo de bloqueio dos membros direito e esquerdo foi de 123 ± 26 e 130 ± 20 minutos, para GE, e de 120 ± 21 e 121 ± 20 minutos, para GLD, sem diferenças entre os grupos ou entre os membros. Conclui-se que o decúbito não interfere na distribuição da lidocaína administrada por via epidural.

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Effects of Epidural Needle Rotation and Different Speeds of Injection on the Distribution of Epidural Block

Cited by 4 publications

References 21 publications

Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients’ Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial

Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients’ Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial

Unilateral Epidural Block: A Persistent Problem with No Good Solution

Dispersão da lidocaína administrada por via epidural em cães posicionados em decúbito lateral ou esternal

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