Identificación del espacio epidural

Distancia de la piel al espacio epidural: correlación con el Índice de Masa Corporal (IMC)


Distance from Skin to Epidural Space: Correlation with Body Mass Index (BMI).
Ravi KK, Kaul TK, Kathuria S, Gupta S, Khurana S.
Clinical Associates, Fortis Hospital, Mohali, India.
J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):39-42.
Abstract
BACKGROUND: Epidural anaesthesia is being increasingly used to provide anaesthesia for surgery on the lower abdomen, perineum and lower extremities. However success of the epidural technique depends upon the correct identification of epidural space. We conducted a study to find the distance from skin to the epidural space and its correlation with body mass index, to improve the success rate. PATIENT AND METHODS: 120 adults patients belonging to ASA physical status I and II in the age group of 18-70 years, scheduled for surgery and or pain relief under epidural block, were taken up for the study. 60 patients of either sex were further subdivided into 2 subgroups of 30 patients each having BMI less than 30 or more than 30. The distance from skin to epidural space was measured as the distance between rubber marker and tip of Tuohy's needle. RESULTS: It was found that with increase in Body mass Index, the distance from skin to the epidural space also increases. The distance from the skin to the epidural space does not depend on the age or the sex of the patients. CONCLUSIONS: WE FORMULATED PREDICTIVE EQUATION OF DEPTH OF EPIDURAL SPACE FROM SKIN IN RELATION TO BMI BASED ON LINEAR REGRESSION ANALYSIS AS: Depth (mm) = a + b (BMI). Where a = 17.7966 and b = 0.9777.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146156/

Identificación del espacio epidural: meta-análisis de complicaciones después de usar aire versus líquidos con la pérdida de la resistencia


Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance.
Schier R, Guerra D, Aguilar J, Pratt GF, Hernandez M, Boddu K, Riedel B.
Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Cologne, Germany. robert.schier@gmx.ne
Anesth Analg. 2009 Dec;109(6):2012-21.
Abstract
BACKGROUND: The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. METHODS: The MEDLINE, EMBASE, and Cochrane databases were searched for prospective, randomized studies comparing air versus liquid as the medium for loss of resistance during epidural space identification in adults. Data were abstracted from 5 studies (4 obstetric and 1 nonobstetric) (n = 4422 patients) that met inclusion criteria and analyzed for the following 6 outcomes: difficult catheter insertion, paresthesia, intravascular catheter insertion, accidental dural puncture, postdural puncture headache, and partial block. RESULTS: The overall risk differences for adverse outcome between the different mediums were not statistically different for the obstetric population. A small, but statistically significant, risk difference for postdural puncture headache was observed when fluid was used during epidural placement for chronic pain management. CONCLUSION: Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss of resistance during epidural block.
http://www.anesthesia-analgesia.org/content/109/6/2012.full.pdf






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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org