Background: Combined spinal-epidural (CSE) anesthesia is the preferred anesthesia method for cesarean delivery. The use of an epidural catheter is essential for administering additional drugs intraoperatively and managing postoperative pain. However, the insertion of epidural catheters is associated with various complications, such as total spinal anesthesia, symptoms indicative of spinal nerve root irritation, and challenges in epidural catheter removal.
Case Summary: We present a case report of a challenging epidural catheter removal due to knotting. The lumbar computed tomography scan results revealed that the catheter formed a tight knot in the epidural space. We used a novel extubation method and successfully removed the catheter.
Conclusion: The operator can use opposite forces to "spiral" apart the spinal joints by positioning the patient's body in a specific position. The findings indicate that, when combined with imaging examination results, this method is effective for the removal of epidural catheters.
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| http://dx.doi.org/10.12998/wjcc.v12.i10.1824 | DOI Listing |
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Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial.
J Clin Anesth
January 2025
Department of Anesthesiology, Sapporo Medical University School of Medicine, 291 South 1 West 16, Chuo-ku, Sapporo-shi, Hokkaido 060-8543, Japan.
Study Objective: We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.
Design: A cadaveric observational study and a clinical randomized controlled trial.
Setting: Sapporo Medical University Hospital.
Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: A prospective, double-blinded, randomised clinical trial.
Eur J Anaesthesiol
February 2025
From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China (XC, YT, QY, LS, HL, LW, CJ, XC).
Background: Rapid onset of epidural analgesia is an important concern for the parturient. Commonly, the local anaesthetic mixture is administered through the epidural catheter. Drugs administered through the epidural needle might decrease the onset time and enhance the spread of medication within the epidural space.
View Article and Find Full Text PDFESAIC focused guidelines for the management of the failing epidural during labour epidural analgesia.
Eur J Anaesthesiol
February 2025
From the Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Madrid, Spain (NB), the Servicio de Anestesia, Hospital Universitario Sanitas La Zarzuela, Madrid, c/ Pleyades, 25, 28023 Madrid, Spain (NB), the Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, P° de la Castellana, 261, 28046 Madrid, Spain (IVG), the Department of Paediatric and Obstetric Anaesthesiology, Juliane Marie Centre, Rigshospitalet & Institute of Clinical Medicine, University Hospital of Copenhagen, Copenhagen, Denmark (AA, KL), the University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany (PK, SR), the Division of Anesthesia Critical Care and Pain, Tel Aviv Sourasky Medical Center affiliated with the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv Israel (CFW), the London North West NHS University Trust, Watford Road, London, UK HA1 3UJ (NL), the Department of Anesthesia & Intensive Care Medicine, Liège University Hospital, Belgium (PYD), the Servicio de Anestesia y Reanimación. Hospital Universitario Fundación Jiménez Díaz. Av. de los Reyes Católicos, 2. 28040 Madrid. Spain (EGA), the Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, Shmuel Beyth St 12, Jerusalem, 9103102 Israel (AI), the Department of Anesthesia and Intensive Care, Akademiska Sjukhuset, Sjukhusvägen, 75185, Uppsala, Sweden (AK), the Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel affiliated with Tel Aviv University Medical School (SOZ), the Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands (OvdB), the Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Belgium (MvdV), the Department of Anaesthesia, Intensive Care and Pain Medicine, University General Hospital of Valencia, Methodology Department, European University of Valencia, Valencia, Spain (CSR).
Background: Labour epidural analgesia reportedly fails in up to 10 to 25% of cases. A joint taskforce of European Society of Anaesthesiology and Intensive Care (ESAIC) experts was created to develop this focused guideline on the management of failing epidural analgesia in a previously well functioning epidural catheter.
Design: Six clinical questions were defined using a PICO (Population/Intervention/Comparison/Outcome) strategy to conduct a systematic literature search.
Improving Thoracic Trauma Care: Locoregional Analgesia in the Intensive Care Unit.
Cureus
December 2024
Intensive Care Unit, Unidade Local Saúde Viseu Dão-Lafões, Viseu, PRT.
Article Synopsis
- Pain management for thoracic trauma patients traditionally relies on opioids, which can have significant side effects; locoregional anesthesia/analgesia (LRAA) offers a targeted alternative.
- The study analyzed 43 LRAA procedures in 33 ICU patients and found that 50% who received LRAA avoided intubation, leading to shorter ICU stays (9 vs. 13 days) and no severe complications from the LRAA techniques.
- Results indicate that early use of LRAA can enhance clinical outcomes for thoracic trauma patients, highlighting its potential but also the need for further investigation to understand its full benefits.
Insufficient Labor Epidural Analgesia Due to Asymptomatic Sacral Perineural Cyst: A Case Report.
Cureus
November 2024
Department of Anesthesiology, Adachi Hospital, Kyoto, JPN.
Lumbar epidural anesthesia is widely used for labor epidural analgesia (LEA), but it often results in insufficient analgesia in the sacral region. We report a case where we performed LEA using lumbar epidural anesthesia, and an asymptomatic sacral perineural cyst was considered the potential cause of inadequate analgesia in the sacral region. A 33-year-old primigravida was admitted with premature rupture of membranes.
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