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Local Anesthetics: Clinical Application as Epidural Anesthesia

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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Ligamentum Flavum Rupture by Epidural Injection Using Ultrasound with SMI Method.

Manabu Maeda¹, Nana Maeda¹, Keisuke Masuda²

¹Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan.

Tomography (Ann Arbor, Mich.)

|February 24, 2023

Summary

This summary is machine-generated.

A novel ligamentum flavum rupture method (LFRM) offers a safer approach for epidural injections. This technique uses injection pressure to rupture the ligamentum flavum, improving accuracy and drug delivery in epidural steroid injections.

Keywords:

epidural injection loss of resistance method lumbar rupture sonography superb microvascular imaging

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Area of Science:

Anesthesiology
Pain Management
Radiology

Background:

The loss of resistance (LOR) method is standard for epidural space identification but carries risks like dural puncture.
Existing devices to improve LOR accuracy have not fully resolved these challenges.

Observation:

A new ligamentum flavum rupture method (LFRM) was developed, placing the needle tip on the ligamentum flavum.
Ultrasound with superb microvascular imaging (SMI) was used to visualize the epidural space and confirm the method's accuracy.

Findings:

LFRM utilizes injection pressure to rupture the ligamentum flavum, facilitating drug spread into the epidural space.
Two cases in elderly males with lower extremity pain demonstrated successful LFRM application.
SMI confirmed accurate parenteral solution spread within the epidural space post-LFRM.

Implications:

LFRM shows promise as an accurate and potentially safer alternative for interlaminar lumbar epidural steroid injections.
This method may reduce the risk of dural puncture associated with traditional LOR techniques.
Ultrasound-guided LFRM could enhance precision in epidural procedures for pain management.