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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

635
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Comparison of Epidural Pressure Decrease Pattern According to Different Lumbar Epidural Approaches.

Jiseob Kim1, Sungwon Jung2, Eunyoung Cho1

  • 1Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Republic of Korea.

Pain Physician
|March 28, 2020
PubMed
Summary
This summary is machine-generated.

The paramedian approach for lumbar epidural injection (LEI) more frequently shows abrupt epidural pressure decrease compared to the midline approach. Patient factors like age, gender, BMI, and diagnosis did not influence pressure decrease patterns.

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Area of Science:

  • Pain Management
  • Anesthesiology
  • Spinal Procedures

Background:

  • Loss of resistance (LOR) sensation is crucial for identifying the epidural space during lumbar epidural injection (LEI), but its absence can lead to procedural failure.
  • Factors like ligamentum flavum paucity or interspinous cysts may contribute to absent LOR sensation.
  • Despite limitations, LOR remains the primary method for epidural space identification.

Purpose of the Study:

  • To analyze patterns of epidural pressure decrease during LEI.
  • To identify factors influencing epidural pressure decrease patterns.

Main Methods:

  • A prospective randomized trial involving 104 patients undergoing LEI for lumbar radiculopathy.
  • Patients were randomized to either a midline or paramedian LEI approach.
  • Analysis included factors such as gender, age, BMI, and diagnosis, with a subgroup analysis of 60 paramedian cases.

Main Results:

  • Three patterns of epidural pressure decrease were identified: Grades I, II (abrupt), and III (gradual).
  • Abrupt pressure decrease was significantly more common with the paramedian approach (P < 0.001).
  • No significant differences in pressure decrease patterns were found based on age, gender, BMI, or diagnosis.

Conclusions:

  • The paramedian approach is associated with a higher frequency of abrupt epidural pressure decrease.
  • Patient demographics and diagnosis do not appear to influence the incidence of epidural pressure decrease.
  • A discrepancy was noted between subjective LOR sensation and objective epidural pressure monitoring.