No abstract available.
Injections, Epidural*

No abstract available.
Injections, Epidural*

A continuous leakage in association with hypovolemia and hypotention of the cerebrospinal fluid is the primary cause of a post-spinal headache. The spinal blood patch is known to be the best choice of treatment for a severe postspinal headache, and measurements of cerebrospinal fluid pressure with saline injection into the lumbar spinal space have been reported. However, a dynamic correlation of the pressure change between epidural and CSF pressure after the epidural injection of the volume has not been known. This study was primarily carried out to investigate dynamic changes and the correlation between epidural and CSF pressure with and without epidural volume injection so that it would be helpful to understand the mechanism as to the immediate and permanent cure, and recurrence of post-spinal headache. Twenty cases were divided into two groups: Group I (control): Normal CSF and epidural pressure were measurd in a sitting position (10 cases) and in a lateral position (10 cases). Group II: CSF and epidural pressure after the injection of 2% lidocaine 10 ml were measured in a sitting position (10 cases) and in a lateral position (10 cases). The differences between CSF and epidural pressure from groups I and II were calculated. The rusults were as follows. CSF pressure: The mean Mean opening pressure was 37.3+/-4.2 cm H2O, mean pressure after injeciton was 41.3+/-6.1 cm H2O and pressure rise was 4 cm H2O (10.7%) in the sitting position, and the mean opening pressure was 9.3+/-3.8 cm H2O mean pressure after injection was 13.9+/-5.2 cm H2O and pressure rise was 4.6 cm H2O (49.5%) in the lateral position. Epidural pressure: The mean initial pressure was 5.82.6 cm H2O, mean pressure after injection was 16.9+/-12.4 cm H2O and pressure rise was 22.7 cm H2O (391.3%) in the sitting posittion, and mean initial pressure was 6.1+4.0 cm H2O, mean pressure after injection was 9.5+ 7.9 cm H2O, and pressure rise was 15.6 cm H2O (255.7%) in the lateral position. Difference between CSF and epidural pressure (CSF pressure-epidural pressure, cm H2O): The mean pressure difference in the control group was 43.1+5.7 cm H2O and mean pressure difference after injection was 24,4+/-12.4 cm H2O in sitting position, and mean pressure difference in the control group was 15.4+/-4.1 cm H2O and mean pressure difference after injection was 4.4+/-10.1 cm H2O in lateral position. It is obvious that the injection of 10 ml of 2% lidocaine reduced the pressure difference greatly between the subarachnoid and epidural spaces. These results indicate that the volume of 10 ml is suitable for an epidural blood patch and it suggests that the patient must be placed in a supine or lateral position immediately after an epidural blood patch is done because of the equalizing of the pressure difference. However, there was still a small difference in pressure between the two compartments: The CSF pressure being higher than the epidural pressure.
Blood Patch, Epidural ; Cerebrospinal Fluid ; Cerebrospinal Fluid Pressure ; Epidural Space ; Headache ; Humans ; Hypovolemia ; Injections, Epidural ; Lidocaine ; Recurrence

No abstract available.
Headache ; Injections, Epidural ; Pneumocephalus

No abstract available.
Injections, Epidural* ; Ultrasonography*

We encountered a case of an accidental epidural injection of ondansetron through an epidural catheter. No neurological complications were noted. This case highlights the need for more attention to minimize the risk of epidural injections.
Catheters ; Injections, Epidural* ; Ondansetron*

The use of fluoroscopy guidance together with the loss of resistance technique during epidural injections has been advocated lately; moreover, epidural injections in the absence of fluoroscopic guidance have a high rate of inaccurate needle-tip placement during the injections. However, the approach to the lower cervical and upper thoracic epidural space may be challenging due to its obscure lateral fluoroscopic views from overlying normal tissue structures. In this case, we report an alternative oblique C-arm fluoroscopy guided view approach to supplement the standard anterior-posterior and lateral fluoroscopic views to facilitate successful needle placement and precise anatomical localization of the epidural space.
Epidural Space ; Fluoroscopy ; Injections, Epidural ; Needles

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

No abstract available.
Colorectal Surgery* ; Injections, Epidural* ; Morphine*

The segmental spread of epidural analgesia was measured in seventeen surgical patients aged between 17 and 52 years, and in fourteen patients between 60 and 77 years. The upper level in the young was 6.29(+/-1.56) thoracic vertebra level, but in the elderly was 4 (+/-0.65_ thoracic vertebra level at 20 minutes after epidural injection of 1.5% lidocaine 20 ml. A given volume of solution spreads to 0.9, 1.07, 1.54, 2.29 segments greater upper extent at 5, 10, 15, 20 minutes after epidural injection and 0.57, 1.07 segments greater lower extent at 5, 10 minutes in the elder than young. So with increasing age relatively small amounts of solution are required, to produce the same extent of anesthesia in the young.
Aged* ; Analgesia, Epidural* ; Anesthesia ; Humans ; Injections, Epidural ; Lidocaine ; Spine