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

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*

No abstract available.
Injections, Epidural* ; Ultrasonography*

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*

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles