Nada EMS, Turan MA, Mohamed MN. Some epidurographic explanations for incomplete epidural analgesia coverage in the absence of a catheter.
J Clin Anesth 2013;
25:565-71. [PMID:
24008196 DOI:
10.1016/j.jclinane.2013.05.006]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 05/19/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
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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