Incidence of Neurologic Complications Related to Thoracic Epidural Catheterization

Giebler, R.; Scherer, R.; Peters, Jürgen

doi:10.1097/00000542-199701000-00009

Cited by 278 publications

(138 citation statements)

References 25 publications

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“…35 In part because ultrasound and pressure monitoring are relatively new technologies, there are no human data to confirm or refute these findings. Finally, there is no clinical evidence in nonanesthetized patients, that approaching the epidural space at the lumbar level is more or less safe than at the thoracic level; 58,59 therefore, there is no reason to assume that either approach is inherently safer in the anesthetized or heavily sedated patient.…”

Section: Regional Anesthesia In Anesthetized or Heavily Sedated Patientsmentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

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Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. KeywordsComplications of anesthesia; Nerve injury; Spinal anesthesia; Epidural anesthesia; Peripheral nerve block; Regional anesthesia; Pain medicine; Transforaminal block The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a group of experts to develop a Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. The goal of this Practice Advisory is to provide information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications. This Practice Advisory focuses on neurologic injuries apart from those caused by hemorrhagic 1 or infectious2 -6 complications, both of which have been the subject of other recent ASRA-sponsored Practice Advisories. The current report is a summation of the Practice Advisory's findings and recommendations. Anesthesiologists are strongly encouraged to read the manuscripts that accompany the present summary document, because they contain the details upon which recommendations are based. The accompanying manuscripts represent most of the subtopics discussed at the conference. The recommendations contained within this Practice Advisory represent the opinions of a small group of expert panelists and are based upon their clinical experience, review of limited scientific literature (anatomic and physiologic studies of animals and human cadavers, case reports, retrospective case series, and non-randomized trials), and open forum discussion. Importantly, in this imperfect setting of controversial topics, limited data, and bias inherent to expert opinion, the Panel consistently tended towards making conservative recommendations. We acknowledge that other experts analyzing the same information may arrive at recommendations different than ours. The recommendations contained herein are not intended to define standard practice or to ensure the avoidance of adverse outcomes. Furthermore, the recommendations are subject to change as new information becomes available. Recommendations from the Practice Advisory are not intended to replace clinical judgment, and specific risk-to-benefit discussions as they pertain to individual patients.Because neurologic injuries related to anesthesia and pain medicine practice are extremely rare, standard tools of evidence-based medicine such as randomized c...

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Section: Regional Anesthesia In Anesthetized or Heavily Sedated Patientsmentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

View full text Add to dashboard Cite

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“…19 Epidural buprenorphine is most likely absorbed rapidly from the epidural space into the systemic circulation and acts centrally in the supraspinal regions to produce analgesia similar to intravenous buprenorphine. 20 Adequate epidural analgesia with buprenorphine for postoperative pain relief has been achieved for coronary artery bypass surgery, 21 gynecologic surgery, 22 genitourinary surgery in children, 23 upper and lower abdominal surgeries, 24 and for the treatment of rib fractures. 25 The epidural dose of buprenorphine ranges from 4 to 8 mg per hour, which is as effective as epidural morphine at a dose of 80 mg per hour for most surgeries.…”

Section: Epidural Buprenorphinementioning

confidence: 99%

Buprenorphine in Postoperative Pain Management

Vadivelu

Anwar

2010

Anesthesiology Clinics

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“…The epidural thoracic blockade is an effective method of anesthesia and postoperative analgesia used worldwide and accidental perforation of the dura-mater is a complication of the technique, demonstrated in only two Brazilian 24,25 and two foreign studies 26,27 . The accidental perforation occurred in 0.4% to 4.4% in the series of 6,496 thoracic epidural blocks and none of the 48 patients developed any neurological sequelae [24][25][26][27] .…”

Section: Replymentioning

confidence: 99%

“…The accidental perforation occurred in 0.4% to 4.4% in the series of 6,496 thoracic epidural blocks and none of the 48 patients developed any neurological sequelae [24][25][26][27] . A possible anatomical explanation for the absence of spinal cord lesion during the accidental perforation of the thoracic dura-mater was proposed by Imbelloni and Gouveia in a study accepted for publication in the November-December issue of the American Journal of NeuroRadiology (AJNR) 28 .…”

Section: Replymentioning

confidence: 99%