Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position = Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position

다국어 초록 (Multilingual Abstract)

Background: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. Methods: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. Results: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. Conclusions: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure. (Korean J Pain 2010; 23: 247-253)

참고문헌 (Reference)

1 Burn JM, "The spread of solutions injected into the epidural space. A study using epidurograms in patients with the lumbosciatic syndrome" 45 : 338-345, 1973

2 Grass JA, "The role of epidural anesthesia and analgesia in postoperative outcome" 18 : 407-428, 2000

3 Genovese A, "Role of mast cells, basophils and their mediators in adverse reactions to general anesthetics and radiocontrast media" 110 : 13-22, 1996

4 Muneyuki M, "Roentgenographic analysis of the positions of catheters in the epidural space" 33 : 19-24, 1970

5 Rodgers A, "Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials" 321 : 1493-, 2000

6 Wills JH, "Rapid onset of massive subdural anesthesia" 30 : 299-302, 2005

7 Sjøgren P, "Lumbar epidurography and epidural analgesia in cancer patients" 36 : 305-309, 1989

8 Mehta M, "Extradural block. Confirmation of the injection site by X-ray monitoring" 40 : 1009-1012, 1985

9 Du Pen SL, "Epidurograms in the management of patients with long-term epidural catheters" 21 : 61-67, 1996

10 Hogan Q, "Epidural catheter tip position and distribution of injectate evaluated by computed tomography" 90 : 964-970, 1999

11 Liu S, "Epidural anesthesia and analgesia. Their role in postoperative outcome" 82 : 1474-1506, 1995

12 Park WY, "Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study" 234 : 560-569, 2001

13 Yokoyama M, "Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia" 100 : 1504-1510, 2004

14 Wong GT, "Contrast-induced nephropathy" 99 : 474-483, 2007

15 Sánchez R, "An analysis of the radiological visualization of the catheters placed in the epidural space" 39 : 485-489, 1967

16 Collier CB, "Accidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence" 29 : 45-51, 2004