RAEducation » epidural http://www.raeducation.com Regional Anesthesia Education...and Discussion Tue, 06 Apr 2010 12:21:26 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 Epidural Catheter Disconnects http://www.raeducation.com/2010/02/epidural-catheter-disconnects/ http://www.raeducation.com/2010/02/epidural-catheter-disconnects/#comments Fri, 26 Feb 2010 23:47:39 +0000 BlueNeedle http://www.raeducation.com/2010/02/epidural-catheter-disconnects/ Yet Another Related Posts Plugin.]]> A 74 year-old female with borderline renal function and a history of spinal stenosis has an epidural catheter in place. She is post-op day 2 from a colon surgery for cancer.

This morning, she was diagnosed with a PE, and was given 1mg/kg of enoxaparin. Six hours after the lovenox, the nurse calls the acute pain service. Apparently the epidural catheter has become disconnected in the last 3 hours (the disconnect was unwitnessed). The tips were found lying on the bed near the patient’s urinal.

How would you manage this situation?

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]]> http://www.raeducation.com/2010/02/epidural-catheter-disconnects/feed/ 3 Unique case of transient profound neurologic deficit resulting from an unusual epidural mass- Case Report http://www.raeducation.com/2009/06/epidural-mass/ http://www.raeducation.com/2009/06/epidural-mass/#comments Sun, 28 Jun 2009 20:32:12 +0000 Veerandra Koyyalamudi http://www.anest.ufl.edu/gator-rap/?p=837 Yet Another Related Posts Plugin.]]> Here is an interesting case report that was published a few years ago (2004) in Anesthesiology.

They describe an episode of profound transient neurological deficit following a difficult thoracic epidural placement ( dural puncture, 3 attempts, T6-T7, T7-T8, T8-T9) in an elderly women undergoing a thoracotomy for repair of a hiatal hernia.

Profound neurological deficit was noticed on the 2nd post op day.

MRI showed an unusual collection of fluid with a high water content extending from T6 to T9 with evidence of spinal cord compression. Minimal heme and no evidence of an abscess.

Link:

http://journals.lww.com/anesthesiology/Fulltext/2004/12000/Transient_Profound_Neurologic_Deficit_Associated.31.aspx

Something to add to our differential diagnoses.

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]]> http://www.raeducation.com/2009/06/epidural-mass/feed/ 3 Utilization of epidural catheters for post-op pain control following scoliosis surgery. http://www.raeducation.com/2009/06/utilization-of-epidural-catheters-for-post-op-pain-control-following-scoliosis-surgery/ http://www.raeducation.com/2009/06/utilization-of-epidural-catheters-for-post-op-pain-control-following-scoliosis-surgery/#comments Sun, 07 Jun 2009 22:27:15 +0000 admin https://www.anest.ufl.edu/gator-rap/?p=807 Yet Another Related Posts Plugin.]]> 67%? This was back in 2001 from an abstract presented at the 2001 Scoliosis Research Society annual meeting from Shriner’s Hospital in Spokane, WA.

Post-Operative Epidural Analgesia for Spine Fusion in Adolescent Idiopathic Scoliosis, Current Utilization at Spine Centers.

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]]> http://www.raeducation.com/2009/06/utilization-of-epidural-catheters-for-post-op-pain-control-following-scoliosis-surgery/feed/ 0 Epidural spread after continuous cervical paravertebral block: a case report. http://www.raeducation.com/2009/05/epidural-spread-after-continuous-cervical-paravertebral-block-a-case-report/ http://www.raeducation.com/2009/05/epidural-spread-after-continuous-cervical-paravertebral-block-a-case-report/#comments Sat, 02 May 2009 00:00:00 +0000 admin PubMed:16701196 Yet Another Related Posts Plugin.]]> Related Articles

Epidural spread after continuous cervical paravertebral block: a case report.

Reg Anesth Pain Med. 2006 May-Jun;31(3):279-81

Authors: Frohm RM, Raw RM, Haider N, Boezaart AP

BACKGROUND AND OBJECTIVE: This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication. CASE REPORT: A healthy 22-year-old male developed bilateral upper-extremity motor weakness immediately after placement of a continuous cervical paravertebral block for postoperative pain control after shoulder stabilization surgery. The tip of the stimulating catheter was demonstrated in the C7 neuroforamen. Contrast injected through the catheter demonstrated epidural spread. The contralateral block resolved after 4 hours and the patient suffered no respiratory embarrassment or other untoward sequelae. CONCLUSION: Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.

PMID: 16701196 [PubMed - indexed for MEDLINE]

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