Pain & Central Nervous System Week

Study results from Chinese University of Hong Kong provide new insights into anesthesia

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"We evaluated the feasibility of performing real-time US-guided paramedian epidural access with the epidural needle inserted in the plane of the US beam in 15 adults who were undergoing groin or lower limb surgery under an epidural or combined spinal-epidural anaesthesia. The epidural space was successfully identified in 14 of 15 (93.3%) patients in 1 (1-3) attempt using the technique described. There was a failure to locate the epidural space in one elderly man. In 8 of 15 (53.3%) patients, studied neuraxial changes, that is, anterior displacement of the posterior dura and widening of the posterior epidural space, were seen immediately after entry of the Tuohy needle and expulsion of the pressurized saline from the LOR syringe into the epidural space at the level of needle insertion. Compression of the thecal sac was also seen in two of these patients. There were no inadvertent dural punctures or complications directly related to the technique described. Anaesthesia adequate for surgery developed in all patients after the initial spinal or epidural injection and recovery from the epidural or spinal anaesthesia was also uneventful," wrote M.K. Karmakar and colleagues, Chinese University of Hong Kong.

The researchers concluded: "We have demonstrated the successful use of real-time US guidance in combination with LOR to saline for paramedian epidural access with the epidural needle inserted in the plane of the US beam.."

Karmakar and colleagues published their study in British Journal of Anaesthesia (Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. British Journal of Anaesthesia, 2009;102(6):845-854).

For more information, contact M.K. Karmakar, Chinese University of Hong Kong, Dept. of Anaesthesia & Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China.

Publisher contact information for the British Journal of Anaesthesia is: Oxford University Press, Great Clarendon St., Oxford OX2 6DP, England.

Keywords: People's Republic of China, Hong Kong, Analgesia, Anesthesia, Neurology, Pain Medicine, Surgery, Chinese University of Hong Kong.

This article was prepared by Pain & Central Nervous System Week editors from staff and other reports. Copyright 2009, Pain & Central Nervous System Week via NewsRx.com.