Epidural Catheter Malposition in a Failed Epidural Anesthesia Confirmed by Computed Tomography

Lee, Se Jin; Kim, Sang Ho; Park, Sun Young; Kim, Mun Gyu; Jung, Bo Il; Ok, Si Young

doi:10.3344/kjp.2011.24.1.44

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Similarly, adverse effects and complications associated with epidural analgesia may be influenced by a number of factors, including epidural catheterization technique, use of intrathecal route and choice of local anesthetic agent and opioid [19][20]. Breakthrough pain after receiving pain relief can increase patient dissatisfaction and may induce fear and worsen anticipatory pain [21].…”

Section: Discussionmentioning

confidence: 98%

Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Lee

Zhu

Moodie

et al. 2017

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 98%

Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Lee

Zhu

Moodie

et al. 2017

Journal of Clinical Anesthesia

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“…Furthermore, although we excluded cases in which the enhanced epidural space was not included in the imaging field of view, cases in which contrast enhancement was not detected because too much time had passed after injection, and cases that could not be evaluated for unknown reasons, it is possible that abnormal findings, such as enhanced subdural space [ 39 – 47 ] and enhanced subarachnoid space [ 24 , 48 ], might not have been diagnosed sufficiently. Although there have been reports of the usefulness of lateral radiography [ 2 , 3 , 49 ] and computed tomography [ 6 , 36 , 50 , 51 ] for the evaluation of contrast enhancement in the epidural space, these imaging studies may be less practical in daily clinical practice because of issues regarding medical costs and procedural simplicity. The present study showed that deviation of an epidural catheter from the epidural space could sufficiently be assessed only with frontal plain abdominal radiographs and that plain abdominal radiography is a simple and useful method to improve the postoperative analgesic effect of epidural anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen

et al. 2016

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BackgroundDuring epidural anesthesia, the catheter tip occasionally deviates from the epidural space into the intervertebral foramen, resulting in inadequate anesthesia.MethodsDuring postoperative plain radiography, iohexol was injected via the epidural catheter to determine its position and to observe the spread of the material. After exclusion of seven patients with catheters that migrated into the subcutaneous area and 25 patients with no evidence of the contrast medium, 415 patients were evaluated. We retrospectively compared patients to determine whether the incidence of deviation into the intervertebral foramen differed between four types of epidural catheters. We also investigated the load applied to the catheter tip using a Shimadzu Autograph AG-X-500 N-111 universal testing machine.ResultsDeviation of the epidural catheter into the intervertebral foramen was observed in eight and 33 patients in the Hakko and Perifix Soft tip catheter groups, respectively. The incidence of deviation was higher in the Perifix Soft tip catheter group, and lower in the FlexTip Plus and Perifix FX catheter groups. A rapid increase was observed in the force exerted on the tips of the Hakko and Perifix Soft tip catheters, while the force transmitted to the tips of the FlexTip Plus and Perifix FX catheters gradually increased and then reached a plateau at a low level.ConclusionsThe incidence of deviation was significantly lower with spiral-type catheters than with other types of catheters. This might be attributable to the gradual transmission of a lower level of force to the tip in spiral-type catheters.

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Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation

Kim

Lee

Sim

et al. 2021

Reg Anesth Pain Med

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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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Epidural Catheter Malposition in a Failed Epidural Anesthesia Confirmed by Computed Tomography

Cited by 4 publications

References 17 publications

Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials

Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen

Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation

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