OBJECTIVE: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery. METHODS: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T RESULTS: The MAP at T CONCLUSION The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.
Anesthesia, General ; Electroacupuncture ; Epidural Space ; Humans ; Nerve Block ; Thoracic Surgery

OBJECTIVE: To review the clinical research progress of spinal epidural lipomatosis (SEL). METHODS: The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. RESULTS: SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. CONCLUSION SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Humans ; Decompression, Surgical/methods* ; Epidural Space/surgery* ; Lipomatosis/surgery* ; Magnetic Resonance Imaging ; Spinal Cord Diseases/surgery*

BACKGROUND: Thoracic epidural analgesia is the mainstay of postoperative pain control after thoracotomy. Usually the epidural catheter is blindly inserted and secured without confirming the tip position. The purpose of this study was to determine the influence of epidural approach angle on the position of the thoracic epidural catheter tip. METHODS: 129 patients scheduled for thoracotomy were enrolled. Patients were randomized into two groups: narrow angle group and wide angle group. The epidural needle was inserted at the skin of T8-9 level in both groups. In the narrow angle group the epidural space was approached at T7-8, whereas in the wide angle group the epidural space was approached at T6-7. After epidural space confirmation, a B-D nylon multi-hole epidural catheter was threaded 8cm into the epidural space. The epidural catheter tip position was assessed using a small amount of radiocontrast dye under fluoroscopy. RESULTS: The mean (95% confidence interval) position of the catheter tip was the mid-body of T5 (T5-6 - T5 upper body) in the narrow angle group and T3-4 (mid-body of T4-T3 lower body) in the wide angle group (P = 0.037). CONCLUSIONS: When approaching the thoracic epidural space by a wide angle, we can place the epidural catheters at a higher level because of a straighter threading.
Analgesia ; Analgesia, Epidural ; Catheterization* ; Catheters* ; Epidural Space ; Fluoroscopy ; Humans ; Needles ; Nylons ; Pain, Postoperative ; Skin ; Thoracic Surgery ; Thoracotomy

Cervical Vertebrae ; Dura Mater ; Epidural Space ; Humans ; Spinal Cord Neoplasms ; surgery

OBJECTIVE: To explore the minimally invasive surgical method for cervical_1-2 epidural neurilemmoma. METHODS: The clinical features, imaging characteristics and surgical methods of 63 cases of cervical_1-2 epidural neurilemmoma from July 2010 to December 2018 were reviewed and analyzed. Pain and numbness in occipitocervical region were the common clinical symptoms. There were 58 cases with pain, 30 cases with numbness, 3 cases with limb weakness and 2 cases with asymptomatic mass. Magnetic resonance imaging (MRI) showed that the tumors located in the cervical_1-2 epidural space with diameter of 1-3 cm. The equal or slightly lower T₁ and equal or slightly higher T₂ signals were found on MRI. The tumors had obvious enhancement. Individualized laminotomy was performed according to the location and size of the tumors, and axis spinous processes were preserved as far as possible. Resection of tumor was performed strictly within the capsule. RESULTS: Total and subtotal resection of tumor were achieved in 60 and 3 cases respectively, and no vertebral artery injury was found. The operation time ranged from 60 to 180 minutes, with an average of 92.83 minutes. The hospitalization time ranged from 3 to 9 days, with an average of 5.97 days. All tumors were confirmed as neurilemmoma by pathology. There was no postoperative infection or cerebrospinal fluid leakage. There was no new-onset dysfunction except 9 cases of numbness in the nerve innervation area. The period of follow-up ranged from 6 months to 8 years (median: 3 years). All the new-onset dysfunction recovered completely. Pain disappeared in all of the 58 patients with pain. Numbness recovered completely in 27 patients while slight numbness remained in another 3 patients. Three patients with muscle weakness recovered completely. The spinal function of all the patients restored to McCormick grade Ⅰ. No recurrence was found on MRI. No cervical spine instability or deformity was found on X-rays. CONCLUSION It is feasible to resect cervical_1-2 epidural neurilemmoma by full use of the anatomical space between atlas and axis and individual laminotomy. It is helpful to prevent cervical instability or deformity by minimizing the destruction of cervical₂ bone and preserving normal muscle attachment to cervical₂ spinous process. Strict intracapsular resection can effectively prevent vertebral artery injury.
Epidural Space/surgery* ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neoplasm Recurrence, Local ; Neurilemmoma/surgery* ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To explore the application of inner plate of frontal sinus-epidural approach in the treatment of anterior skull base cranio-nasal communication tumors. METHOD: A study of 6 cranio-nasal communication tumor patients was undertaken. They were treated with lateral rhinotomy-inner plate of frontal sinus-epidural approach to remove tumor. RESULT: The tumors in all the 6 patients were completely resected. The follow-up study during the following 2 years revealed that 5 patients had good facial appearances and showed no tumor recurrence, no cerebrospinal rhinorrhea, no meningoencephalocele, no frontal collapse, and other complications. CONCLUSION The surgical approach in the treatment of Cranio-nasal communication tumors needs to be chosen according to the tumor size, location and nature. Lateral rhinotomy-inner plate of frontal sinus-epidural approach can be carried out independently by the head and neck surgeons. It is a valuable surgical treatment with minimal invasion, short surgery time, little damage to brain, and easy pyrosis of skull base.
Adult ; Epidural Space ; surgery ; Female ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Nose Neoplasms ; parasitology ; surgery ; Paranasal Sinus Neoplasms ; pathology ; surgery ; Skull Base Neoplasms ; pathology ; surgery

This study describes the successful use of modified dorsolumbar epidural anesthesia with a fixed volume of anesthetic in a bovine referral center. Among the 130 Holstein cattle scheduled for flank surgery, 90 cattle received a mixed anesthetic consisting of 1 ml of xylazine hydrochloride and 3 ml of lidocaine hydrochloride by modified dorsolumbar epidural anesthesia. Eighteen cattle with dehydration and/or lameness received a mixed anesthetic containing 0.5 ml of xylazine and 3 ml of lidocaine. Infiltration anesthesia was performed in 22 cattle whose epidural space could not be reached in order to perform the flank surgery. The surgeries began about 12 min after the administration of the anesthetic and lasted for about 36 min. The modified method using a fixed volume of anesthetic was successfully introduced and effectively used in a bovine referral center. This modified method will allow veterinarians to save time and effort, thus lowering the cost of each surgery.
Anesthesia, Epidural/methods/*veterinary ; Anesthetics, Local/*administration & dosage ; Animals ; Cattle/*surgery ; Epidural Space ; Female ; Lidocaine/*administration & dosage ; Lumbar Vertebrae ; Xylazine/*administration & dosage

BACKGROUND: Although thoracic epidural analgesia is a common practice in neuroaxial blockade for effective post-operative pain relief especially in major abdominal or thoracic surgery, difficult access to the thoracic epidural space is a frequent problem and can cause neurological complications like spinal cord injury and total spinal block. To minimize complications, we should to guess the distance for thoracic epidural space before this procedure. METHODS: One hundred fifty patients having preoperative upper abdominal computed tomography (CT) for diagnosis of their disease presented to major abdominal operation requiring mid-thoracic epidural analgesia for postoperative pain relief. The patient was placed in the sitting position and the levels of T7 and T8 spinous processes were identified. Using a paramedian approach with loss of resistance technique, when the insertion angles of Tuohy needle was measured by a protractor; inward angle (alpha) to the sagittal plane and downward angle (beta) to the transverse section of the spine. Entry of the needle into the epidural space, actual length (A) of the needle was marked and then measured with a ruler. Reviewing the abdominal CT films using the Picture Archiving and Communication System (PACS), the distance (B) from epidural space to skin on the transverse CT plane was measured at the corresponding to T7-T8 seemed to the level of the lowest scapular. The estimated length (Ac) of the skin to the epidural space was calculated by principle of trigonometry with alpha, beta and B. RESULTS: Mean (SD) age, height, weight, BMI were 56 (11) yr, 164 (6.9) cm, 61 (11.5) kg, and 37 (6.2) kg/m2, respectively. The A, B, Ac value and alpha, beta were 5.4 (0.77), 4.3 (0.76), 5.4 (0.85), 12 (3.4)o, 33 (9.6)o. There were significant correlation of both actual length of the needle and the estimated distance on CT film. Actual length of the needle tended to have 1.25 times longer than the estimated distance on CT film. There were also significances both A and weight, BMI, but not age, height. CONCLUSIONS: The distance from epidural space to skin measured on the transverse CT plane may be helpful as a guide for mid-thoracic epidural catheter insertion.
Analgesia, Epidural ; Catheters ; Diagnosis ; Epidural Space* ; Humans ; Needles ; Pain, Postoperative ; Skin* ; Spinal Cord Injuries ; Spine ; Thoracic Surgery ; Tomography, X-Ray Computed

Epiduroscopy is very useful in the treatment of not only low back pain caused by failed back surgery syndrome, epidural scar or herniated disc but also by chronic refractory low back pain which does not respond to interventional conservative treatment including fluoroscopically-directed epidural steroid injections and percutaneous adhesiolysis. Because cauterization using a laser fiber has become recently available, a wider opening is required to enter into the sacral canal in the case of epiduroscopic laser neural decompression (ELND). However, in a few patients, it is difficult to insert a device into the epidural space due to stenosis around the opening, and there is no alternative method. Herein, we report a case where a hiatus rasp specially designed for such patients was used to perform the operation.
Cicatrix ; Constriction, Pathologic ; Decompression ; Epidural Space ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Low Back Pain

PURPOSE: DepoDur(R) is a single-dose extended-release morphine injection into the epidural space. It is not commonly used, but has many advantages over traditional analgesic regimens. We analyzed a number of these advantages in our case series in the context of the colorectal enhanced recovery program (ERP) and aimed to show that the ERP could be further enhanced by using DepoDur(R). METHODS: We conducted a prospective audit of all patients undergoing open and laparoscopic colorectal procedures where DepoDur(R) was used between July 2010 and April 2012. Validated pain scores were used, and primary outcome measures were resting and dynamic pain, mobilization, and need for additional analgesia. RESULTS: Two hundred eighty patients were included in the case series. Good pain control was seen at 24 and 48 hours. Eighty-one percent of the patients required simple analgesia alone at 24 hours, and 62% required simple analgesia (paracetamol +/- nonsteroidal anti-inflammatory drugs) alone at 48 hours. Only a minority required additional oramorph and patient-controlled analgesia at 24 and 48 hours (19% at 24 hours and 38% at 48 hours). Seventy-nine percent of the patients were mobilized at 24 hours, and 88% of the patients were mobilized at 48 hours. CONCLUSION: DepoDur(R) is an effective alternative to conventional pain management techniques and may have a role in further enhancing the ERP.
Analgesia ; Analgesia, Patient-Controlled ; Colorectal Surgery* ; Epidural Space ; Humans ; Morphine* ; Outcome Assessment (Health Care) ; Pain Management ; Postoperative Period ; Prospective Studies