Paramedian Lumbar Epidural Catheter Insertion with Patients in the Sitting Position Is Equally Successful in the Flexed and Unflexed Spine

Podder, Subrata; Kumar, Neeraj; Yaddanapudi, Lakshmi Narayana; Chari, Pramila

doi:10.1213/01.ane.0000136774.99702.14

Cited by 31 publications

(21 citation statements)

References 10 publications

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“…Compared with its midline counterpart, the paramedian approach results in fewer needle redirections, 42,43 decreased resistance/paresthesia/vascular breach with catheter advancement, 42,43 less resistance with LA injection, 42 decreased need for spinal flexion, 43 less procedural pain, 43 and a shorter time for catheter insertion. 44 Furthermore, because it circumvents interspinous ligament cysts and midline gaps in ligamentum flavum, it could theoretically decrease the rate of false-positive LOR.…”

Section: Paramedian Approachmentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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Section: Paramedian Approachmentioning

confidence: 99%

Confirmation of Loss-of-Resistance for Epidural Analgesia

Tran

González

Bernucci

et al. 2015

Regional Anesthesia and Pain Medicine

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“…The median approach is the most common technique used, but it is technically difficult, especially in geriatric patients, because they have degenerative changes in the structural components of their spine. The paramedian approach is sometimes preferred because of faster catheter insertion (11), fewer attempts at needle insertion (12), and possibility of performing the procedure in an unflexed spinal position (13); furthermore, identification of the epidural space may be easier with the paramedian technique. This technique is also less affected by osteoarthritic changes in the elderly population; however, the oblique direction is likely to cause problems when inserting the catheter-over-needle system through the epidural needle.…”

Section: Post Dural Puncture Headache In Median and Paramedian Approamentioning

confidence: 99%

Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients

et al. 2011

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A B S T R A C TBackground: Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH. Objectives: In this study we aimed to compare the incidence of PDPH in the case of median and paramedian approaches in patients undergoing spinal anesthesia for orthopedic operations. Patients and Methods:Patients scheduled for orthopedic surgery under spinal anesthesia between 2007 and 2008 were studied in a double-blinded randomized controlled trial. The patients were randomized to receive spinal anesthesia by either a median (n = 75) or paramedian (n = 75) approach through a 25-gauge Crawford needle. No premedication was given, and all patients received 500 mL of normal saline intravenously and 4 mL of 0. 5% isobaric Marcaine 30 minutes prior to surgery in both approaches. Results: Fifteen patients (10%) developed PDPH. There was no significant difference in the incidence of PDPH in both groups, with 7 (9.3%) patients in the median approach group versus 8 (10.7%) in the paramedian approach group developing typical PDPH (P = 0.875). However, a significant difference in PDPH incidence (P = 0.041) was observed between females (9; 16.7%) and males (6; 6.3%). Conclusions: There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males.

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“…Jaucot et al (1986) noted lower incidence of paraesthesia (22% vs. 42.5%) and vascular puncture using paramedian approach. 10 In our study, statistical analysis shows that the occurrence of bloody tap in paramedian epidural approach was 6% (3 patients) while it was 16% in median epidural approach [p 0.03]. The number of bloody tap was higher in median epidural approach.…”

Section: Number Of Attempts To Find the Epidural Spacementioning

confidence: 49%

“…9 Subrata Podder, MD et al, Neeraj Kumar, MD, L. N. Yaddanapudi, MD and Pramila Chari, MD-noted that seventeen patients in the midline group required more than two attempts for epidural insertion, with active flexion of the back required for needle insertion. 10 Only one patient in the paramedian group required more than two attempts, p<0.01. There was more resistance to catheter advancement (p = 0.023), blood in the catheter (p = 0.022), and paraesthesia (p= 0.010).…”

Section: Number Of Attempts To Find the Epidural Spacementioning

confidence: 90%

“…Jaucot et al (1986) study noted difference in catheter stiffness may play a significant role, Catheter insertion was significantly faster and easier using paramedian epidural technique. 10 Blomberg R et al 4 (1989) found resistance to catheter insertion less common with paramedian approach. Nishimoto N 14 , Hibi K, Ueno O, et al noted that insertion of a catheter by paramedian lumbar epidural puncture was found to be with less resistance compared to the median epidural technique.…”

Section: Pain During Catheterisationmentioning

confidence: 99%

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A Comparative Study of Median and Paramedian Techniques to Identify the Lower Thoracic Epidural Space and Catheter Insertion for Upper Abdominal Surgeries

Raja¹,

Lenin²,

Elango³

et al. 2017

jemds

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BACKGROUND Epidural is a central neuraxial blockade with various applications. The epidural space was first described by Corning in 1901. And Fidel Pages first used epidural analgesia in humans in 1921. Fidel Pages described the interspinous approach to the epidural space and reported satisfactory anaesthesia for abdominal procedures. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in Surgery, Obstetrics and Pain relief. Both single injection and catheter techniques can be used. Its versatility means it can be used as an anaesthetic, an adjuvant to general anaesthesia and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. This study compares the median and paramedian epidural techniques to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries. METHODS AND MATERIALSThis is a comparative, randomised, double-blinded prospective study comparing median and paramedian approaches to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries in two groups of patients comprising of fi fty patients each. The observations were analysed using Epi info software and ANOVA measure for students' test and Chi-square test to compare the data between the two groups. RESULTSThis study shows paramedian approach of identification lower thoracic epidural space has less number of attempts, less incidence of dural tap, easy insertion of catheter, less incidence of pain, less time taken to identify the epidural space and less resistance to catheter insertion than the median approach. CONCLUSIONThe location of epidural space in patients posted for upper abdominal surgeries was found to be easier and has lesser complication by paramedian approach when compared to median epidural approach.

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Paramedian Lumbar Epidural Catheter Insertion with Patients in the Sitting Position Is Equally Successful in the Flexed and Unflexed Spine

Cited by 31 publications

References 10 publications

Confirmation of Loss-of-Resistance for Epidural Analgesia

Confirmation of Loss-of-Resistance for Epidural Analgesia

Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients

A Comparative Study of Median and Paramedian Techniques to Identify the Lower Thoracic Epidural Space and Catheter Insertion for Upper Abdominal Surgeries

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