Epidural steroid injection (ESI), which is commonly used for treatment of low back pain with lumbosacral radicular pain, can be performed via transforaminal, interlaminar, or caudal routes. The transforaminal route is generally regarded as more effective than the interlaminar route due to its high level of drug delivery to the ventral epidural space. However, in some postoperative patients, use of the transforaminal route may be difficult. Thus, there is an urgent need for technology that can offer more effective drug delivery to the ventral epidural space with fewer complications. In this context, we describe a case about our new method where patient has undergone oblique interlaminar lumbar epidural steroid injection (OIL-ESI) instead of transforaminal ESI. We treated a patient with OIL-ESI instead of transforaminal ESI. Patient was symptomatic improved at postoperative visits. Based on our findings, OIL-ESI may be a suitable alternative to transforaminal ESI.
Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Low Back Pain* ; Methods ; Pain Management

Epidural steroid injection (ESI), which is commonly used for treatment of low back pain with lumbosacral radicular pain, can be performed via transforaminal, interlaminar, or caudal routes. The transforaminal route is generally regarded as more effective than the interlaminar route due to its high level of drug delivery to the ventral epidural space. However, in some postoperative patients, use of the transforaminal route may be difficult. Thus, there is an urgent need for technology that can offer more effective drug delivery to the ventral epidural space with fewer complications. In this context, we describe a case about our new method where patient has undergone oblique interlaminar lumbar epidural steroid injection (OIL-ESI) instead of transforaminal ESI. We treated a patient with OIL-ESI instead of transforaminal ESI. Patient was symptomatic improved at postoperative visits. Based on our findings, OIL-ESI may be a suitable alternative to transforaminal ESI.
Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Low Back Pain* ; Methods ; Pain Management

Lumbar radicular pain is conventionally treated with transforaminal epidural injection under the guidance of fluoroscopy or computer tomography. However, fluoroscopic radiation can be hazardous in certain populations, including pregnant women. An adjustment of the amount of local anesthetic is required in this population. An alternative method of lumbar root block using ultrasound (US) guidance has recently been introduced. Here, we present the case of a pregnant woman with worsening lumbar radicular pain during her pregnancy and the management of her pain using US-guided pararadicular block.
Female ; Fluoroscopy ; Humans ; Injections, Epidural ; Low Back Pain* ; Methods ; Pregnancy ; Pregnant Women* ; Ultrasonography

Autologous blood injected into the epidural space of 10 patients with a postlumbar puncture headache resulted in immediate and lasting cure except for one patient, due to technical failure to obtain proper identification for epidural injection. No serious complications were noticed in these cases except one who developed severe lower back pain radiating to the right leg immediately after epidural injection. A headache is the commonest untoward complication of spinal puncture. The clinical applications of many of the methods of treating post lumbar puncture headaches have been most unsatisfactory. This method of treating postspinal headaches, which has only been introduced recently, namely epidural blood patch, has resulted in immediate, satisfactory and permanent relief. It is to be noted that possible additional complications may be produced. therefore an absolute indication must be evaluated to avoid additional complications before the blood patch method is used. The amount of blood and the site of injection must be considered as an important factor to prevent post blood patch complications. The possible complications from autologous blood injections into th eepidural space are as follows: 1. Nerve root compression from epidural hematoma injected for blood patch. 2. Development of epidural hematoma by injuring venous plexus. Particularly dangerous secondary problems come from patients with purpura, scurvy, hemophilia, leukemia and anticoagulant therapy. 3. Tendency of epidural abscess caused by the blood being a good media for bacterial growth. 4. Localized back pain and lumbago. 5. Persistent headache aggravated by inadvertent subdural puncture. 6. Possibility of adhesive arachnoiditis.
Adhesives ; Arachnoid ; Arachnoiditis ; Back Pain ; Blood Patch, Epidural ; Epidural Abscess ; Epidural Space ; Headache* ; Hematoma ; Hemophilia A ; Humans ; Injections, Epidural ; Leg ; Leukemia ; Low Back Pain ; Methods ; Punctures* ; Purpura ; Radiculopathy ; Scurvy ; Spinal Puncture

From September 1979 through April 1980, we had carried out continuous lumbar epidural anesthesia(2% lidocaine, 20ml) with small dose of morphine and single dose caudal anesthesia(2% lidocaine, 15-20ml) for 16 cases of lumbar laminectomy,And also we observed the effects of postanesthetic pain relief by administered morphine(2mg) into lumbar epidural space, The results of this study were as follows: 1) Age distribution was from 20 to 60 years, sex distribution was 14 in man and 2 in woman, and physical status was in ASA class I in all cases. 2) The site of herniated intervertebral disc was L4~5 in 15 cases and L3~4 in one, The epidural puncture site was selected 2~3 vertebral segments cephalad from the lesion, 3) The morphine amount administered with lidocaine into lumbar epidural space was 2mg in all cases. 4) The duration of pain relief from the induction of anesthesia was average 17. 5 hours, and from the additional epidural injection of morphine(2mg) in ward was average 13.5 hours. 5) There was no neurological deficit or sequele except nausea in one case postoperatively. Therefore this anesthetic method was not only satisfactory for laminectomy but also safer and simpler in the fixation of spinal anesthetic level by patient's position change than spinal anesthesia, and faster in the postanesthetic ambulation than general anesthesia. Moreover, surgeon's acceptability.
Age Distribution ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthesia, Spinal ; Epidural Space ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc ; Laminectomy* ; Lidocaine ; Methods ; Morphine* ; Nausea ; Punctures ; Sex Distribution ; Walking

Low back pain and sciatica is a common cause of physical disability and reduces the activity of the patient, which have a negative effect to a society and enigmatic to the concerned physician. Concerning to thecauses of low back pain and sciatica, direct mechanical compression exerted by protruded disc material on nerve roots has been widely accepted as a main factor. There is, however, a good deal of indirect evidence, which suggests that inflammatory changes, present in and around affected nerve roots, may also be of importance in the production of the pain. One hundred and twelve patients suffering from low back pain and/or sciatica.have been treated by epidural injection of methyl-prednisolone acetate 80mg and l% lidocaine 4cc, at Wonju Christian Hospital, Yonsei University Wonju Medical College from June, 1979 to April, 1983. Present study was done to analyse the effect of epidural steroid injection on low back pain and sciatica. The success of the injection was assessed strictly according to the subjective response of the patient. The results of this study are as follow: The overall effect of the epidural steroid injection; 26 patients(23%) were completely relieved of symptoms, 33 patients(29%) were markedly improved, 23 patients(21%,) were moderately improved, 30 patients(27%) stated that they had no relief from the injection. 2. As for a major causative disease of low back pain and sciatica, herniated lumbar disc, 65 patients(58%), was found. Secondly, 12 patients(11%) was degenerative spondylitis and 11 patients (10%) was lumbar sprain. 3. The patients who had only low back pain or sciatica without neurologic deficit showed much better improvement as 91 and 88. 4. A better result noted in the patients had symptoms for three months or less comparing with the patients having symptoms longer than three months. 5. The patients wiho had not been treated or concervatively treated prior to the injection represented better improvement comparing with the patients previously by surgical method. 6. Thirty eight(68%) of 56 patients who had history of trauma, and 44 patients(79%) of 56 patients who had no previous trauma history showed a moderate or better improvement. 7. No significant difference was found in the effect of injection according to ficdings of the routine roentgenography and myelography. 8. The patients who were responsible for the expenses of the treatment showed better improvement. 9. The symptoms were recurred in 19 patients(17%) within two months, and five of whom experienced marked and moderate pain improvement with second injection. The results suggest that the epidural steroid injection is relatively simple method with rere complication and more effective for treatment of low back pain and sciatica which may prevent the chronic pain when it is performed in the early stage with other conservative treatment.
Chronic Pain ; Gangwon-do ; Humans ; Injections, Epidural ; Lidocaine ; Low Back Pain ; Methods ; Myelography ; Neurologic Manifestations ; Radiography ; Sciatica ; Spondylitis ; Sprains and Strains

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. METHODS: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. RESULTS: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. CONCLUSIONS: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.
Administration, Intravenous ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, Epidural ; Humans ; Injections, Epidural ; Laparoscopes ; Laparoscopy ; Methods ; Morphine ; Nefopam ; Oxycodone ; Pain Measurement ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Pica ; Prostatectomy ; Thoracic Vertebrae

OBJECTIVE: To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. MATERIALS AND METHODS: Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. RESULTS: The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 microGy.m2 at L2-4, 100.6 microGy.m2 at L5, and 72.1 microGy.m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010). CONCLUSION: The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.
Adult ; Aged ; Aged, 80 and over ; Female ; Fluoroscopy/*methods ; Humans ; Injections, Epidural ; Low Back Pain/drug therapy ; Lumbosacral Region/*innervation ; Male ; Middle Aged ; *Radiation Dosage ; Young Adult

OBJECTIVE: To establish a rapid and simple gas chromatographic-mass spectric method for qualitative and quantitative analysis of lidocaine in blood and cerebrospinal fluid(CSF). METHODS: Following an acidification of HCl, blood or CSF was alkalinized with NaOH (pH=9) and extracted with ether for two times. Evaporated in a water bath and with an air velocity of nitrogen gas, extract was dissolved with ethanol and analyzed by a gas chromatographic-mass spectrum method, lidocaine was analyzed qualitatively and quantitatively by GC/MS (SIM:86, 58, 72, 87). RESULTS: Linear range of lidocaine detected in blood or CSF by this method is 1.0-60.0 microg x mL(-1) (r=0.9999), the minimum detected concentration of lidocaine was 0.02 microg x mL(-1) (S/N=3), recovery is at 85%-103%. This method was used in the determination of lidocaine in dog model died of the anesthesia with lidocaine. CONCLUSION This study provided a gas chromatographic-mass spectric analysis for lidocaine in blood and CSF. This method was more selective, little interferefering, more sensitivities and simpler. It could be used in the detection of lidocaine in biological fluids.
Anesthesia, Epidural ; Anesthetics, Local/cerebrospinal fluid* ; Animals ; Dogs ; Forensic Medicine ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Injections, Intravenous ; Lidocaine/cerebrospinal fluid* ; Sensitivity and Specificity

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.
Analgesia ; Analgesia, Patient-Controlled ; Decompression ; Humans ; Injections, Epidural ; Methods ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Spinal Stenosis ; Vomiting