Epidural anesthesia for placement of spinal cord stimulators with paddle-type electrodes

Placement of paddle electrodes for spinal cord stimulation is usually performed under local anesthesia as the patient must be alert and cooperative during the procedure. This is often difficult, and involves significant discomfort for the patient. We explore the placement of spinal cord stimulators (SCS) under epidural anesthesia.

Fifteen consecutive patients underwent single-shot epidural anesthesia prior to placement of the SCS. Patient perception of paresthesias during intraoperative stimulation was compared to preoperative pain dermatomes indicated by the patient. The ability to produce paresthesias as well as the voltage required to produce paresthesias under anesthesia were recorded. Patient demographics, amount and concentration of epidural drugs, use of local anesthetic or sedatives, and any complications were also recorded.

Epidural anesthesia was successfully induced in 14 patients. All patients were alert and cooperative. Paresthesias in appropriate dermatomes were induced in all patients. No local anesthetic or sedatives were used. The voltage required to induce paresthesias was double that required to maintain stimulation once the epidural had worn off.

Epidural anesthesia provides a safe and effective means of placing SCS with paddle-type electrodes. There is no patient discomfort, and paresthesias are consistently elicited in appropriate areas in all patients.