Aspiración del aire inyectado vía catéter epidural como indicador de colocación correcta del catéter en el espacio epidural |
The Aspiration of Injected Air via an Epidural Catheter as an Indicator for Appropriate Placement of the Catheter in the Epidural Space Soon Ho Cheong, M.D., Dae Sik Park, M.D., Sung Ho Moon, M.D., Kwang Rae Cho, M.D., Sang Eun Lee, M.D., Young Hwan Kim, M.D., Se Hun Lim, M.D., Jeong Han Lee, M.D., Kun Moo Lee, M.D., Young Kyun Choe, M.D., Young Jae Kim, M.D., and Chee Mahn Shin, M.D.
Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Gupo Sungsim Hospital, Busan, Korea Korean J Pain 2009; 22: 124-129.
Background: The "gold standard" for proper epidural catheter positioning is a clinical response, as assessed by a pinprick test. Yet it may take time or it may be difficult to perform this test after epidural catheter placement in sedated or uncooperative patients or during general anesthesia. We assessed the usefulness of aspirating injected air via an epidural catheter as an indicator of correct epidural catheter placement. Methods: We surveyed 200 patients who underwent surgery under general or epidural anesthesia. A Tuohy needle was inserted into the epidural space with using the hanging drop technique. After placement of the epidural catheter, 3 ml of air was injected via the catheter, and then the volume of aspirated air was measured. Results: The mean volume of aspirated air was 2.3 ± 0.7 ml (75% of the injected air volume) and this ranged from 0 to 3 ml. Conclusions: Aspiration of injected air is a simple alternative method for identifying the appropriate placement of epidural catheters in the epidural space
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Uso de medio de contraste para determinar la posición postoperatoria del catéter peridural |
Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position
Tetsuya Uchino, MD, Satoshi Hagiwara, MD, Hideo Iwasaka, MD, Kyosuke Kudo, MD, Junji Takatani, MD, Akio Mizutani, MD, Masahiro Miura, MD*, and Takayuki Noguchi, MD Departments of Anesthesiology and Intensive Care Medicine, *Human Anatomy, Oita University Faculty of Medicine, Yufu, Japan
Korean J Pain 2010; 23: 247-25
Background: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. Methods: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. Results: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. Conclusions: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.
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