The Position of Plastic Tubing in Continuous-block Techniques

Bridenbaugh, L. Donald; Moore, Daniel C.; Bagdi, Phyllis A.; Bridenbaugh, Phillip O.

doi:10.1097/00000542-196809000-00035

Cited by 65 publications

(19 citation statements)

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“…Although insertion to greater lengths reduces the possibility of dislodgement, it potentially leads to side‐effects such as intravenous cannulation, paresthesia, and unilateral sensory analgesia (1, 2). Irrespective of whether the catheter is passed easily into the epidural space through the needle opening, there may be a considerable difference between the distance from the puncture site to the tip of the catheter and the length of catheter inserted as a result of coiling (3–7).…”

mentioning

confidence: 99%

Coiling of lumbar epidural catheters

Lim

Bahk

Ahn

et al. 2002

Acta Anaesthesiol Scand

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mentioning

confidence: 99%

Coiling of lumbar epidural catheters

Lim

Bahk

Ahn

et al. 2002

Acta Anaesthesiol Scand

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“…Conversely, if a greater length of the catheter is threaded in, there is uncertainty regarding the position of the catheter and the possibility of extrusion of the catheter through the intervertebral foramen [16][17][18]; probably this is the reason why a higher incidence of unsatisfactory analgesia was seen with 8-cm insertion in our study (13.3% in the 8-cm group and 6.7% in the 4-cm group). Radiological evidence reported by Bridenbaugh et al [15] also suggested that only 12% of all epidural catheters directed in a cephalad direction actually threaded to the "hoped for" anatomic levels, while 21% of the catheters had a terminal loop, 48% coiled at the insertion site, and 5% went in a caudal direction or migrated out through an intervertebral foramen. However, these investigators did not correlate the failure rate or the sensory level of epidural analgesia to the attained catheter position.…”

Section: Discussionmentioning

confidence: 94%

“…The coiling length was similar irrespective of the cephalad (1-5.5 cm) or caudal direction (1.5-8 cm) of the needle. Bends were noted on the removed catheters, suggesting that after being advanced a short distance into the epidural space, the catheters became coiled within the epidural space [12,15,16]. A catheter bends when the tip confronts the dura mater, blood vessels, connective tissue, and neural structures that may hinder its advancement [4].…”

Section: Discussionmentioning

confidence: 99%

Insertion length and resistance during advancing of epidural catheter

et al. 2009

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“…The paramedian approach to the epidural space is thought to have fewer potential technical problems than the midline approach because of the anatomical characteristics of the thoracic epidural space [23]. However, identification of the epidural space itself using the loss-of-resistance technique seems to be more difficult with the paramedian approach and may result in a higher complication rate, especially when the catheter passes out through a foramen on the opposite side [23][24][25]. The use of the midline approach is not free from this complication [26].…”

Section: Discussionmentioning

confidence: 99%

Accidental pleural puncture by a thoracic epidural catheter

Zaugg¹,

Stoehr²,

Weder³

et al. 1998

Anaesthesia

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SummaryWe report the occurrence of an accidental pleural puncture by an epidural catheter that happened during the attempted induction of thoracic epidural anaesthesia using a paramedian approach in an awake patient. The incorrect placement of the catheter was recognised while the patient was undergoing thoracoscopic surgery. The possibility of accidental pleural puncture during attempted thoracic epidural catheter placement by either the paramedian or the midline approach should be borne in mind. A misplaced catheter may injure lung tissue and result in a potentially dangerous intra-operative tension pneumothorax.Keywords Anaesthetic techniques, regional; epidural, thoracic. Complications. ...................................................................................... Correspondence to: Dr A. Zollinger Accepted: 23 March 1997 Thoracic epidural anaesthesia is frequently used in combination with general anaesthesia to achieve excellent peri-operative analgesia in patients undergoing upper abdominal and thoracic surgery [1, 2]. The technique may be associated with beneficial respiratory and haemodynamic effects [3][4][5]. However, this procedure is not free from complications, which include dural puncture with high spinal block [6, 7], blood vessel puncture with subsequent formation of an epidural haematoma [8,9], prolonged arterial hypotension, transection and knotting of the catheter [10], infection [11,12] and neurological sequelae [13]. Only a few cases of accidental puncture of the pleural cavity after thoracic epidural anaesthesia have been reported [14][15][16]. We report a case with direct intraoperative visualisation of the thoracic epidural catheter perforating the parietal pleura in a patient undergoing video-assisted thoracoscopic surgery. Case historyA 73-year-old female patient (height: 149 cm, weight: 60 kg) with chronic pneumonia of the right lower lobe was referred for diagnostic thoracoscopic lung biopsy. Her chest X-ray showed an encapsulated pleural effusion in the midzone of the right lung. Pre-operative laboratory data, lung-function tests and electrocardiogram were all normal. The patient had no history of spinal pathology.Routine monitoring was attached to the patient, who was positioned in the right lateral position with her knees bent and her spine flexed. The space between the spinous processes of the sixth and seventh thoracic vertebrae (T 6/7 interspace) was infiltrated with local anaesthetic. A 16G Tuohy needle (Portex Ltd, Hythe, Kent, UK) was inserted into the T 6/7 interspace using a right-sided paramedian approach (2 cm to the right of the midline). The loss-ofresistance technique was used with the aid of a 10-ml saline-filled glass syringe. The needle was advanced perpendicular to the skin until it hit the vertebral lamina on the right side. The tip of the needle was then redirected in the mediocranial direction and the typical loss of resistance was felt 7 cm deep to the skin. The epidural catheter was threaded 3 cm beyond the tip of the needle without any problems...

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The Position of Plastic Tubing in Continuous-block Techniques

Cited by 65 publications

References 0 publications

Coiling of lumbar epidural catheters

Coiling of lumbar epidural catheters

Insertion length and resistance during advancing of epidural catheter

Accidental pleural puncture by a thoracic epidural catheter

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