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Frouin M, Cavalerie R, Piazza S, Baudin-Tréhiou C, Blond L. Presumed post-traumatic subdural hygroma in a 2.5-year-old spayed female Chihuahua. Vet Radiol Ultrasound 2024. [PMID: 38566563 DOI: 10.1111/vru.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/17/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
A 2.5-year-old spayed female Chihuahua dog was presented with chronic cervical pain and exhibited a "prayer-like position" following a history of a 4-meter fall. CT and MRI revealed a moderate right-sided enlargement of the subdural space with cerebrospinal fluid, consistent with a subdural hygroma, appearing connected to a quadrigeminal cistern dilation. Percutaneous transfontanellar external drainage of the subdural fluid accumulation did not prevent its re-accumulation, and the dog was managed medically, leading to the complete resolution of clinical signs. The subdural hygroma was suspected to be secondary to the previous trauma.
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Affiliation(s)
- Maxime Frouin
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Robin Cavalerie
- Department of Neurology, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Stéphanie Piazza
- Department of Neurology, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Clément Baudin-Tréhiou
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - Laurent Blond
- Department of Diagnostic Imaging, Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
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2
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Elhamrawy A, Syed A, Smith T, Veneziano G, Tobias JD. Management of Post-Dural Puncture Headaches in Pediatric Patients with Epidural Blood or Saline Patch: An Educational Focused Review. J Pain Res 2024; 17:1197-1207. [PMID: 38524695 PMCID: PMC10960508 DOI: 10.2147/jpr.s444381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
Post-dural puncture headache (PDPH) is a common adverse outcome following puncture of the dura. It can occur after inadvertent dural puncture during epidural catheter placement or following diagnostic or therapeutic LP. The incidence of PDPH in pediatric patients has been estimated at 1-15% depending on patient factors (age, gender, body mass index) and needle factors (size and needle bevel/point type). The larger the needle gauge, the higher the incidence of PDPH. Various options have been proposed to treat PDPH including observation, bed rest, hydration, caffeine, and epidural blood/saline patch. The current manuscript provides a review of the use of epidural blood/saline patch in pediatric-aged patients with PDPH.
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Affiliation(s)
- Amr Elhamrawy
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Ahsan Syed
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy Smith
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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3
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Calineata M, Jennewein L, Neef V, Flinspach AN, Louwen F, Zacharowski K, Raimann FJ. Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study. J Clin Med 2023; 12:5770. [PMID: 37762712 PMCID: PMC10532051 DOI: 10.3390/jcm12185770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. METHODS In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. RESULTS The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005]. CONCLUSIONS LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.
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Affiliation(s)
- Martin Calineata
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Lukas Jennewein
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Armin Niklas Flinspach
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Frank Louwen
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Florian Jürgen Raimann
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Kong W, Du Q, Xin Z, Cao G, Liu D, Wei Y, Liao W. Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma. Front Surg 2022; 9:915133. [PMID: 36303856 PMCID: PMC9592838 DOI: 10.3389/fsurg.2022.915133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions. METHODS This was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded. RESULTS The remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32-78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5-15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points. CONCLUSION PFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.
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Affiliation(s)
- Weijun Kong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijun Xin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangru Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dexing Liu
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yiyong Wei
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wenbo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China,Correspondence: Wenbo Liao
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5
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Ukai T, Kosuke H, Ebihara G, Watanabe M. Comparison of periarticular multidrug infiltration and epidural catheter use in total knee arthroplasty: A prospective randomized controlled study. J Orthop Surg (Hong Kong) 2020; 28:2309499020910663. [PMID: 32208889 DOI: 10.1177/2309499020910663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of periarticular multidrug infiltration (PMDI) and compare it with that of epidural catheter use. METHODS Fifty-eight patients (58 joints) who underwent total knee arthroplasty were included in this single-center, prospective, parallel, randomized, controlled trial. Preoperatively, patients were randomly categorized into the PMDI and epidural catheter groups. We evaluated postoperative pain (visual analog scale (VAS) and narcotic consumption), functional outcomes (range of motion (ROM) of knee flexion, the day patients could perform the straight-leg raising (SLR) test, and day of starting cane use), and laboratory data (white blood cell (WBC) and C-reactive protein (CRP)). RESULTS There was no significant difference in the VAS score, ROM of knee flexion, the day patients could do SLR, and the day of starting cane use between the PMDI and epidural catheter groups. However, the PMDI group could perform SLR on a postoperative day (POD) 1 (p < 0.05). WBC level on POD 1 was significantly higher in the PMDI group (p < 0.05), whereas the CRP levels on POD 1 (p < 0.01), 3 (p < 0.01), and 5 (p < 0.01) were significantly lower in the PMDI group than in the epidural catheter group. The frequency of side effects was not significantly different between the groups. CONCLUSION PMDI was as effective as epidural catheter use for pain control. A higher percentage of patients who underwent PMDI could perform SLR on POD 1; therefore, the functional recovery was earlier in the PMDI group than in the epidural catheter group. PMDI may suppress inflammation in the whole body because of steroids.
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Affiliation(s)
- Taku Ukai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hamahashi Kosuke
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Goro Ebihara
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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6
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Manassero A, Bossolasco M, Carrega M, Coletta G. Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients. Local Reg Anesth 2020; 13:111-119. [PMID: 32982397 PMCID: PMC7490049 DOI: 10.2147/lra.s272410] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. Patients and Methods Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml−1 fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects. Results A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded. Conclusion Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.
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Affiliation(s)
- Alberto Manassero
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Matteo Bossolasco
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Mattia Carrega
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Coletta
- Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy
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Puthenveettil N, Sandhya S, Joseph N, Nair S, Paul J. Comparison of cross-legged sitting position with the traditional sitting position for the ease of insertion of an epidural catheter in parturient for providing labour analgesia: A randomised control trial. Indian J Anaesth 2020; 64:199-203. [PMID: 32346166 PMCID: PMC7179790 DOI: 10.4103/ija.ija_786_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/06/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: The patient's position during the insertion of the epidural catheter plays a major role in the success of labour analgesia. In our study, we compared the ease of insertion of the epidural catheter in either traditional sitting position (TSP) or crossed-legged sitting position (CLSP). The primary objective was to compare the number of successful first attempts at epidural placement between the groups. Secondary objective included patient comfort, ease of landmark palpation and the number of needle-bone contacts. Methods: The prospective non-blinded randomised control study was conducted on 50 parturient with uncomplicated pregnancy during active labour. Patients were randomly assigned into two groups using a computer-generated random sequence of numbers by closed envelope technique. Group TSP received epidural in a traditional sitting position and group CLSP received an epidural in a crossed-legged sitting position with knee and hip flexed. Results: The parturient in both groups were comparable with respect to the distribution of age, height, weight and parity. The baseline visual analogue score (VAS) and VAS scores at 15 min were comparable between groups. Percentage of a parturient with successful epidural placement in the first attempt was higher in CLSP group than in TSP group (88% versus 44%, P = 0.004). The landmark, needle-bone contact and comfort during positioning were comparable between the two groups. Conclusion: Cross-legged sitting position is a better position than the traditional sitting position for the ease of insertion of labour epidural catheter.
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Affiliation(s)
- Nitu Puthenveettil
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sai Sandhya
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Nandhini Joseph
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sobha Nair
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Toleska M, Naumovski F, Dimitrovski A. Accidental injection of succinylcholine into epidural space as a test dose. Saudi J Anaesth 2020; 14:238-240. [PMID: 32317884 PMCID: PMC7164469 DOI: 10.4103/sja.sja_646_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/31/2023] Open
Abstract
Inadvertent injection of nonepidural drugs into the epidural space is a rare situation, which is under-reported, and can lead to serious complications, such as cardiovascular and respiratory complications, paraplegia, or quadriplegia, and can worsen the patients' outcome from surgery. Succinylcholine administered epidurally leads to the appearance of fasciculation and shortness of breath and can prolong neuromuscular blockade. We report a case of accidental administration of 100 mg of succinylcholine via an epidural catheter as a test dose instead of 2 ml 0.5% bupivacaine in a patient planned for major abdominal surgery. After 2 min, the patient complained of shortness of breath; dysarthria; and fasciculation in the trunk, upper limbs, and face. This was managed with induction to general anesthesia (GA). In the postoperative period, no neurological or cardiovascular complications were observed. There is no adequate drug as an antidote of accidentally given nonepidural drugs via an epidural catheter. Succinylcholine given via epidural catheter has been shown to prolong neuromuscular blockade. Proper labeling and storage of syringes are of utmost importance for avoiding these unpleasant situations.
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Affiliation(s)
- Marija Toleska
- University Clinic for TOARILUC, Department of Anesthesia and Intensive Care, Medical Faculty, University "Ss. Cyril and Methodius" - Skopje, Republic of Macedonia
| | - Filip Naumovski
- University Clinic for TOARILUC, Department of Anesthesia and Intensive Care, Medical Faculty, University "Ss. Cyril and Methodius" - Skopje, Republic of Macedonia
| | - Aleksandar Dimitrovski
- University Clinic for TOARILUC, Department of Anesthesia and Intensive Care, Medical Faculty, University "Ss. Cyril and Methodius" - Skopje, Republic of Macedonia
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9
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Abstract
Coagulopathy either from the use of anticoagulant, antiplatelet, or thrombolytic medications or from underlying medical conditions is considered one of the major risk factors for epidural hematoma formation related to epidural catheter placement or removal. The American Society of Regional Anesthesia and Pain Medicine (ASRA) has laid down guidelines regarding timing of neuraxial blockade or removal of neuraxial catheters in patients receiving either antithrombotic or thrombolytic therapy. We present a case of acute onset of paraplegia because of an epidural hematoma following removal of the epidural catheter in a patient who was given the first dose of antithrombotic therapy after the removal of the epidural catheter as per the ASRA guidelines. The epidural hematoma was diagnosed with an urgent magnetic resonance imaging, and the patient was urgently taken up for surgical evacuation of the hematoma. The patient made full recovery over 1 week period.
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Affiliation(s)
- Nitin Madhukar Bhorkar
- Department of Anaesthesiology and Surgical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Tasneem Saleh Dhansura
- Department of Anaesthesiology and Surgical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
| | | | - Sanket Sharad Mehta
- Department of Anaesthesiology and Surgical Oncology, Saifee Hospital, Mumbai, Maharashtra, India
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10
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Abstract
Introduction Epidural anesthesia is frequently used to provide postoperative analgesia following major surgical procedures. Secure fixation of the epidural catheter is necessary to prevent premature dislodgment and loss of epidural analgesia. Using an in vitro model, the current prospective study evaluates different types of dressings for securement of an epidural catheter by quantifying the force in Newtons (N) required for dislodgment using a digital force gage. Methods Four methods of epidural catheter securement were used on a simulator mannequin: 1) Suresite® Window Clear Dressing, 2) Op-Site Post-Op® Visible Dressing, 3) Steri-Strips® and Suresite Window Clear Dressing, and 4) Steri-Strips and Op-Site Post-Op Visible Dressing. Each method of securement was assessed 10 times to calculate the mean force required to dislodge the catheter. Mean force of dislodgment for each method was compared using parametric tests. Results The force (mean ± SD) required for catheter dislodgment for the four methods was 14.0±2.9, 2, 10.7±1.5, 8.6±2.3, and 9.6±2.2 N, respectively. The pairwise difference showed that the Suresite Window Clear Dressing was the best securement method when compared with other methods. Conclusion Our study demonstrates the advantage of the Suresite Window Clear Dressing in securing the epidural catheter. Future clinical trials are needed to validate these findings.
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Affiliation(s)
- Mohammed Hakim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | | | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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11
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Abstract
Pain and symptom management is a cornerstone of palliative and hospice medicine. The aim of this article is to educate clinicians about the uncommon causes of bleeding from an epidural catheter for hospice pain management. A case of a 12-year-old female with progressive metastatic rhabdomyosarcoma-left forearm primary who had exhausted all treatment options is reported. She had a very significant cancer-related pain, which was not amenable to hospice management at home. A tunneled epidural catheter was placed so that she could receive better pain management at home as her life expectancy was very short. The patient had massive bleeding coming from the tunnel site developing big clots around dressings on the third day after the catheter placement. All methods for stopping the bleeding were employed but it stopped only after the epidural catheter was removed. In conclusion, the development of pain management strategy using multidisciplinary inputs with appropriate, timely use of interventional pain management techniques provides satisfactory pain relief for these patients and reduces distress in patients and relatives during this difficult period. Multiple approaches exist for pain management; however, systemic medications sometimes cause additional side effects (nausea, vomiting, constipation, drowsiness, respiratory depression). Unfortunately, some interventional procedures may also have side effects (bleeding, infection, ineffectiveness).
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Affiliation(s)
- Lisgelia Santana
- Anesthesiology and Pain Management, Nemours Children's Hospital, Orlando, USA
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12
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Ristev G, Sipes AC, Mahoney B, Lipps J, Chan G, Coffman JC. Initiation of labor analgesia with injection of local anesthetic through the epidural needle compared to the catheter. J Pain Res 2017; 10:2789-2796. [PMID: 29263693 PMCID: PMC5732563 DOI: 10.2147/jpr.s145138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The rationale for injection of epidural medications through the needle is to promote sooner onset of pain relief relative to dosing through the epidural catheter given that needle injection can be performed immediately after successful location of the epidural space. Some evidence indicates that dosing medications through the epidural needle results in faster onset and improved quality of epidural anesthesia compared to dosing through the catheter, though these dosing techniques have not been compared in laboring women. This investigation was performed to determine whether dosing medication through the epidural needle improves the quality of analgesia, level of sensory blockade, or onset of pain relief measured from the time of epidural medication injection. Methods In this double-blinded prospective investigation, healthy term laboring women (n=60) received labor epidural placement upon request. Epidural analgesia was initiated according to the assigned randomization group: 10 mL loading dose (0.125% bupivacaine with fentanyl 2 µg/mL) through either the epidural needle or the catheter, given in 5 mL increments spaced 2 minutes apart. Verbal rating scale (VRS) pain scores (0–10) and pinprick sensory levels were documented to determine the rates of analgesic and sensory blockade onset. Results No significant differences were observed in onset of analgesia or sensory blockade from the time of injection between study groups. The estimated difference in the rate of pain relief (VRS/minute) was 0.04 (95% CI: −0.01 to 0.11; p=0.109), and the estimated difference in onset of sensory blockade (sensory level/minute) was 0.63 (95% CI: −0.02 to 0.15; p=0.166). The time to VRS ≤3 and level of sensory block 20 minutes after dosing were also similar between groups. No differences in patient satisfaction, or maternal or fetal complications were observed. Conclusion This investigation observed that epidural needle and catheter injection of medications result in similar onset of analgesia and sensory blockade, quality of labor analgesia, patient satisfaction, and complication rates.
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Affiliation(s)
- Goran Ristev
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Angela C Sipes
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan Mahoney
- Department of Anesthesiology, Mount Sinai St. Luke's and Mount Sinai Roosevelt, New York, NY, USA
| | - Jonathan Lipps
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gary Chan
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Abstract
Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.
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Affiliation(s)
| | - Amala G Kudalkar
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Smita M Gaikwad
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Shailendra Modak
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Hema B Gupta
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Bharati A Tendolkar
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
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14
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Ishikawa Y, Imagama S, Ito Z, Ando K, Gotoh M, Nishiwaki K, Nagao Y, Ishiguro N. Delayed Onset of Subdural Hematoma following Epidural Catheter Breakage. Global Spine J 2016; 6:e1-6. [PMID: 26835209 PMCID: PMC4733371 DOI: 10.1055/s-0035-1549030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 02/09/2015] [Indexed: 11/03/2022] Open
Abstract
Study Design Case report. Objectives To describe a case of delayed-onset spinal hematoma following the breakage of a spinal epidural catheter. Methods The authors describe the clinical case review. Results A 64-year-old woman had undergone epidural anesthesia 18 years before she was referred to our hospital because of lower-back pain and lower neurologic deficit with leg pain. The clinical examination showed the presence of a fragment of an epidural catheter in the thoracolumbar canal, as assessed by computed tomography, and a spinal hematoma that compressed the spinal cord at the same spinal level, as assessed by magnetic resonance imaging. Surgical removal of the epidural catheter and decompression surgery were performed. The patient exhibited substantial clinical improvement 1 month after surgery; she achieved a steady gait without the need for a cane and had no leg pain. Conclusion This is the first report of delayed onset of spinal hematoma following the breakage of an epidural catheter. Generally, when the breakage of an epidural catheter occurs without symptoms, follow-up alone is recommended. However, because spinal hematoma might exhibit a late onset, the possibility of this complication should be considered when deciding whether to remove the catheter fragment. We believe that in our patient, there could be a relationship between the catheter fragment and subdural hematoma, and catheter breakage could have been a risk factor for the spinal hematoma.
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Affiliation(s)
- Yoshimoto Ishikawa
- Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan,Address for correspondence Shiro Imagama, MD Department of Orthopedic SurgeryNagoya University School of Medicine65 Tsurumai-cho, Showa-ku, Nagoya 466-8550Japan
| | - Zenya Ito
- Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University School of Medicine, Nagoya, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University School of Medicine, Nagoya, Japan
| | - Yoshimasa Nagao
- Department of Quality of Patient Safety, Nagoya University School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan
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15
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Abstract
A bolus of 0.125% bupivacaine (8ml) was given for post-operative analgesia with considerable resistance. It was immediately followed by hemodynamic deterioration along with fall in sensorium. After resuscitation, CT brain revealed pneumoencephalus around the brainstem. The higher force generated during injection could have injured epidural venous plexus and air inadvertently entered the veins. The source of air could have been from the epidural catheter or injection syringe. Hence it is suggested that position and patency of the epidural catheter must be checked each time before administration of injections especially after position changes. On presence of slightest resistance, injections should be withheld till the cause is ascertained by a trained personnel.
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Affiliation(s)
- Sharmili Sinha
- Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Banambar Ray
- Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar, Odisha, India
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16
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Heo BH, Pyeon TH, Lee HG, Kim WM, Choi JI, Yoon MH. Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management. Korean J Pain 2014; 27:139-44. [PMID: 24748942 PMCID: PMC3990822 DOI: 10.3344/kjp.2014.27.2.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/10/2014] [Accepted: 02/19/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. METHODS We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. RESULTS The average score for the numerical pain rating scales for the 29 patients decreased from 7 ± 1.0 at baseline to 3.6 ± 1.4 on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. CONCLUSIONS Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.
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Affiliation(s)
- Bong Ha Heo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Hee Pyeon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Gon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ha Yoon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
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17
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Carpenter W, Afshar N, Mihara K. Spinal epidural abscess with discitis and vertebral osteomyelitis. J Gen Intern Med 2012; 27:1560. [PMID: 22570107 PMCID: PMC3475823 DOI: 10.1007/s11606-012-2066-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/31/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Will Carpenter
- VA Hospital, 4150 Clement St., San Francisco, CA, 94121, USA.
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18
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Ambert V, Braticevici B, Damian D, Chira I, Iconaru V, Radu T, Constantin T. Radical prostatectomy in the treatment of prostate cancer. The experience of the Urology Clinic of Prof. Dr. Th. Burghele Clinical Hospital. J Med Life 2009; 2:279-87. [PMID: 20112472 PMCID: PMC5052500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION radical prostatectomy remains a real challenge for most of the urologists. Our study's objective is bringing into discussion the main aspects related to the technique we use, the intra and post-operatory complications, as well as the short-term analysis of the results in PC treatment using RP in the Prof. Dr. Th. Burghele Clinical Hospital - Clinic of Urology. MATERIAL AND METHODS between 1999 and 2007, 59 patients with PC, aged 48-74, were operated in our clinic. We began to recommend prostate biopsy (PB) to all patients with PSA higher than 4 ng/ml and, in the last years, higher than 2,5 ng/ml. A change in our attitude is related to the PB. At the beginning, we tried to perform "targeted" punctions, ultrasound guided especially in suspect zones, afterwards, we performed randomised punctions at all the patients, no matter the aspect of TRUS and we have increased the number of punctions accordingly to the prostate volume (minimum 6 punctions, maximum 12). The most used was the 10 core punction. The T classification, according to the clinical diagnosis, of the 59 operated patients: T1 cT1 a-b--4 cases; cT1 c--39 cases; T2 cT2 a--12 cases; cT2 b-c--4 cases. The RP surgical technique was the classic one, described by P.C. Walsh--the first surgical step, in all cases was lymphadenectomy. RESULTS of all the patients that went through RP, 56 cases are still in our records. We can consider healed 24 patients with PC, followed for 3 years post-surgery, because they had no need of therapy and the PSA is maintained below 0.02 ng/ml. The Gleason score--between the pre-operatory established diagnosis by punction and the anatomic-pathological examination of the piece, there were some differences: the concordance was in 48% of the cases; in 39% of the patients, the biopsy specimen had a lower Gleason score than the surgery specimen, and in 13% a higher score, the most common error was caused by sampling. The correlation between the pre-operatory evaluated clinical stage and the pathological clinical stage was of 57%. The most important late postoperative complications of RP were: urinary incontinence and erectile dysfunction. In our study, we have recorded late postoperative: complete urinary incontinence in 4 cases (6.7%), erection was maintained after bilateral preservation of neurovascular bandelets in 90% of cases and after unilateral preservation in 71% of cases. Due to the short following period, we can't say if the operated patients by us had a benefit regarding the general surviving period; The personalized interpretation of the increase of serum PSA levels after surgery represents a possible problem regarding the indication of complementary treatment.
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Affiliation(s)
- V Ambert
- „Prof. Dr. Th. Burghele” Clinical Hospital
| | | | - D Damian
- „Prof. Dr. Th. Burghele” Clinical Hospital
| | - I Chira
- „Prof. Dr. Th. Burghele” Clinical Hospital
| | - V Iconaru
- „Prof. Dr. Th. Burghele” Clinical Hospital
| | - T Radu
- „Prof. Dr. Th. Burghele” Clinical Hospital
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