Some epidurographic explanations for incomplete epidural analgesia coverage in the absence of a catheter - 04/12/13

Doi : 10.1016/j.jclinane.2013.05.006

Eman M.S. Nada, MD, PhD ^a,^b,^c,^{^⁎} : Resident, Mehmet Alparslan Turan, MD ^d : Associate Staff, Mona N. Mohamed, MD, PhD, MPH ^e,^f : Assistant Professor
^a Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
^b Assistant Consultant, Department of Anaesthesia and Pain Management, King AbdulAziz Medical City Saudi Arabia, Riyadh, Saudi Arabia
^c Lecturer, Department of Anesthesia, Alexandria University, Alexandria, Egypt
^d Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
^e Department of Neuroradiology, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
^f Professor, Department of Radiology, Ain Shams University, Cairo, Egypt

^⁎Correspondence: Eman M.S. Nada, MD, PhD, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 515, Little Rock, AR 72205, USA. Tel.: +1 216 835 6071; fax: +1 501 686 7059.

Abstract

Study Objective

To determine the impact of the plica mediana dorsalis (PMD) on injected contrast media spread in the epidural space.

Design

Prospective interventional study.

Setting

Academic medical center.

Patients

30 chronic pain patients ranging in age from 37 to 71 years, undergoing epidural steroid injection.

Interventions and Measurements

Epidurograms were evaluated for the 1) presence or absence of a PMD and 2) bilateral differential density and the extent of contrast spread on either side of the midline, horizontally and vertically.

Results

The PMD (defined as midline radiolucency in epidurograms) was observed in (80%) 24/30 patients based on the epidurograms that were evaluated. Denser contrast spread on one side was found in (79%) 19/24 patients who had the PMD and in (33%) 2/6 patients who did not have the PMD (P = 0.03). Horizontal and vertical asymmetrical spread of the contrast was observed in (67%) 16 of 24 patients with the PMD and in (50%) 3 of 6 of patients without the PMD in each direction independently.

Conclusion

The difference in density of contrast spread on either side of the midline carries important clinical implications in understanding the pathogenesis of inadequate epidural analgesia and/or unilateral excessive motor weakness or numbness.

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Keywords : Analgesia: labor, Contrast spread, Epidurography, Plica mediana dorsalis, Obstetrical anesthesia

Plan

Introduction

Materials and methods

Results

Discussion

☆	Note: The study was done at King AbdulAziz Medical City Saudi Arabia, P.O. Box 22490, Riyadh 11426, Saudi Arabia (Tel: 00-966-1-2-520-088-14572; IRB No. RC 07/032).
☆☆	Supported by departmental funding only.

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Vol 25 - N° 7

P. 565-571 - novembre 2013 Retour au numéro

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Some epidurographic explanations for incomplete epidural analgesia coverage in the absence of a catheter - 04/12/13

Abstract

Study Objective

Design

Setting

Patients

Interventions and Measurements

Results

Conclusion

Plan

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