Since Sicard, Cathlin and Tuffier performed the first sacral extradural anesthetic technique in 1901, surprisingly increased interest in this technique and basic investigation has been done concerning the anatomy, the physiology, and the fate of the local anesthetic in the body, after in jection in the epidural space. Recently, a decreasing interest in peridural anesthesia and nerve block thechniques have resulted from the availability of more efficacious and more safe volatile anesthetics. However in case of contraindication of both general and spinal anesthesia, this caudal anesthesia should be available and very usefull. Authers have undertaken to evaluate the circulatory effect of caudal anesthesia with the injection of lidocain into the epidural space through the sacral hiatus. Ten cases were selected and observed the change of the cardiovascular system before and after caudal anesthesia. The changes of the heart rate and systolic blood pressure between pre-and post anesthesia were insignificant statistically.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics ; Blood Pressure ; Cardiovascular System ; Epidural Space ; Heart Rate ; Lidocaine* ; Nerve Block ; Physiology

Interscalene bracheal plexus block has became a popular method of anesthesia for surgical operation on the upper extremities. Possible complications are subarachnoid block, epidural block, phrenic nerve block, vagus or recurrent laryngeal nerve block, sympathetic nerve block, intravascular injection. But reported complications has been few and generally without prolonged effects. The following describes a patient who developed signs and symptoms suggestive of inadvertent phrenic nerve block and epidural anesthesia as complications of interscalene bracheal plexus block The complications were attributed to using of inferomedially directed 5 cm needle and then additional blind block of the brachial plexus with 5 or 6 times. We emphasize that if the appropriate length of needle and technique are not used, phrenic nerve paralysis and serious complications including total spinal or epidural block can occur as a result of a medially misdirected needle.
Anesthesia ; Anesthesia, Epidural ; Autonomic Nerve Block ; Brachial Plexus ; Humans ; Needles ; Paralysis* ; Phrenic Nerve* ; Recurrent Laryngeal Nerve ; Upper Extremity

The changes of onset and duration of caudal epidural anesthesia had been compared in 54 patients schedulled for perianal surgery at kyungpook National University HospitoL The patients were divided into 3 groups of 18: lidocaine group received 2% lidocaine 20 ml, mixture group received 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml and bupivcaaine group received 0.5% bupivacaine 20 ml. The onsets were as follows. The onsets wiere 3.11+/-0.63 in lidocaine group, 4.83+/-4.17 in mixture group and 8.13+/-3.49 min in bupivacaine group. The onset of bupivacaine group was slower than lidocaine group(p<0.01) and late compared with mixture group(p<0.5). The duration of caudal anesthesia were 192.00+/-62.49 in lidocaine group, 326.72+/-145.28 in mixture group and 419.22+/-125.37min in bupivacaine group. Significant differences were observed between mixture-lidocaine group(p<0.01), bupivacaine-lidocaine group(p<0.01) and bupivacaine-mixture group(p<0.05). Urinary catheteiized patients were 8 in longest duration group of bupivacaine. It is suggested from the above'results that the mixture of lidocaine and bupivacaine during caudal epidural anesthesia can produce rapid onset and long duration.
Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthetics, Local* ; Bupivacaine ; Gyeongsangbuk-do ; Humans ; Lidocaine

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

After an accidental experience of epidural anesthesia by Corning in 1885, the development of Tuohy needle, the discovery of a better local anesthetic, epidural anesthesia came into common usage in clinical anesthesia. Epidural anesthesia is more modern as a regional anesthesia than spinal anesthesia because of the low incidence of hypotension, controllability of the duration of anesthesia time, and the absence of postspinal headache. A total of 1,168 epidural anesthesia cases encountered in Severance hospital during the period of January 1, 1978 to December 31, 1982 were subjected to this clinical evaluation. The results are as follows: 1) The percentage of epidural anesthesia comprised 2.8% of total anesthesia cases. 2) The most common age groups listed in order of decreasing grequency were those in the seventh decade, third decade, and sixth decase. 3) The most common ASA physical status listed in order of decreasing frequency were those in the Class ll, Class l, Class lll. 4) The common agents of local anesthetics used were 1.5 or 2% lidocaine and sometimes bupivacaine. Additive agents such as morphine sulfate for postoperative pain control and epinephrine for prolongation of anesthesia time were used commonly. 5) The most common site of anesthesia was the sixth thoracic vertebral sensory segmental level, but a higher site for sensory anesthesia than required for the operation performed was frequently encountered. 6) The most common complications of epidural anesthesia were hypotension(21.1%) with infrequently dural puncture, traumatic tapping, bradycardia, convulsion, and catheter sequestration. In conclusion, epidural anesthesia is considered to be a safe regional anesthesia that will reduce the incidence of hypotention provided that careful control of the sensory level to be anesthetized is taekn under consideration along with the age, physical status, and operation site of the patient.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics, Local ; Bradycardia ; Bupivacaine ; Catheters ; Epinephrine ; Headache ; Humans ; Hypotension ; Incidence ; Lidocaine ; Morphine ; Needles ; Pain, Postoperative ; Punctures ; Seizures ; Zea mays

Epidural anesthesia is often preferred over spinal anesthesia because of it's more gradual onset of action and less precipitous hypotension. But, there may be a delay in onset and incomplete blockade at I and S1 segments due to the large size of these nerve roots. Increasing the pH of local anesthetic solution toward the physiologic range has been reported to improve the quality of neural blockade in vitro. Local anesthetic solution applied to a nerve membrane exits in two forms, nonionized free base and charged ionized cation. An increase in the nonionized fraction of local anesthetics associated with an increase in pH results in improved nerve penetration and more rapid onset time of nerve blockade. This study was undertaken to determine the effect of increase in the pH of the lidocaine solutions used for epidural administration on time of onset of sensory blockade and quality of motor blockade. One hundred ten patients having epidural anesthesia for lower extremity orthopedic procedures, perineal and lower abdominal procedures were randomly assigned to two groups and the following local anesthetic solutions were epidurally injected. Group 1 received 2 % lidocaine solution with 1; 200,000 epinephrine and group 2 received 2% lidocaine solution with 1; 200,000 epinephrine plus l mEq of NaHCO added per 10 ml of lidocaine solution. The onset of sensory blockade was measured by pin prick test, and onset time of analgesia was defined as the time between the completion of anesthetic injection and loss of pinprick sensation. Motor blockade was assessed by modified Bromage scale every 5 minutes for 30 min. Blood pressure and pulse rate were measured before epidural injection and every 5 min after injection for 30 min. Results were as follows; 1) Time to onset of anaIgesia at L1, T10, T5 S1 dermatome were significantly more rapid in group that received the alkalinized Iidocaine solution. 2) Degree of motor blockade were significantly more intense in alkalinized lidocaine group from 5 min to 25 min. 3) The decrease in systolic pressure in alkalinized group were more rapid than control group. In conclusion, when lidocaine plus epinephrine alkalinized with bicarbonate was used during epidural bloekade, quality of neural blockade was improved and onset of anesthesia and development of systolic hypotension were more rapid.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Anesthetics, Local ; Blood Pressure ; Epinephrine ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Injections, Epidural ; Lidocaine* ; Lower Extremity ; Membranes ; Nerve Block ; Orthopedic Procedures ; Sensation

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Caudal ; Anesthesia, Epidural* ; Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine

Caudal anesthesia appears to be a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. From January 1990 to December 1992, we examined the trend and distribution of the 1038 cases of caudal anesthesia retrospectively according to year, age, surgieal department, type of operation, operation time, local anesthetics and suecess rate. Annual numbers of caudal anesthesia increased with years and the first decade of life was the greatest number. The most common department and operation time were general surgery and 30~60 minutes. 2% or 1% lidocaine with epinephrine was the major local anesthetics used during caudal anesthesia and overall success rate was 95.5%.
Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Conduction ; Anesthetics, Local ; Epinephrine ; Lidocaine ; Narcotics ; Retrospective Studies ; Umbilicus

Spinal cord stimulation (SCS) in trials involving external stimulation are easily conducted under local anesthesia. However, implantation of a permanent SCS system is painful, and can be intolerable in some patients. Epidural anesthesia can be used to perform the SCS implantation without discomfort if the patient can localize the area of paresthesia. However, little is known about epidural anesthesia for SCS. This paper reports 23 cases of permanent SCS with a cylindrical type lead implanted under the epidural anesthesia. Epidural anesthesia was sufficient in 22 patients without discomfort and significant complications. The remaining patient experienced incomplete epidural anesthesia and required additional analgesics to blunt the pain. All the leads were placed consistent with the patient's report of paresthesia area under epidural anesthesia. Thus, epidural anesthesia is an effective and safe method for the optimal placement of SCS to minimize the discomfort for patients without impairing patients' response to the intraoperative stimulation test.
Analgesics ; Anesthesia, Epidural* ; Anesthesia, Local ; Humans ; Paresthesia ; Spinal Cord Stimulation*

BACKGROUND: Iliac crest bone graft (ICBG) harvesting is associated with significant perioperative pain and opioid consumption. This randomized controlled trial sought to determine if the transversalis fascia plane (TFP) block provides effective analgesia for anterior ICBG harvesting. METHODS: Fifty patients undergoing wrist fusion surgery with anterior ICBG harvesting were randomized to receive a TFP block with either 20 ml of 0.5% ropivacaine or 5% dextrose. Patients additionally received a brachial plexus block for primary surgical-site anesthesia and either a general or spinal anesthetic depending on patient preference. Primary outcomes of interest were perioperative opioid consumption (measured as intravenous morphine equivalents [IME]), pain intensity at the ICBG harvest site for up to 48 h postoperatively, and the incidence of persistent postoperative pain at 6 and 12 months after surgery. RESULTS: The TFP group used less opioid in the post-anesthetic care unit (PACU) (median 0 vs. 2.5 mg IME, P = 0.01) and in the first 8 h following PACU discharge (median 2.5 vs. 13.0 mg IME, P = 0.02). The patients who received a TFP block also had lower pain scores in PACU (median 0 vs. 4.0 out of 10, P < 0.001). Although opioid consumption and pain scores were lower in the TFP group at later timepoints, this difference was not statistically significant. Persistent pain at the ICBG site was reported in only 4.3% and 6.5% of all patients at 6 and 12 months, respectively. CONCLUSIONS: The TFP block provides effective early analgesia for anterior ICBG harvesting. The incidence of persistent postoperative pain was low.
Analgesia ; Anesthesia ; Anesthesia, Local ; Brachial Plexus Block ; Fascia ; Glucose ; Humans ; Incidence ; Morphine ; Nerve Block ; Pain, Postoperative ; Patient Preference ; Transplants ; Wrist