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Fluoroscopically Guided Thoracic Interlaminar Epidural Injection: A Comparative Epidurography Study Using 2.5 mL and 5 mL of Contrast Dye

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Author(s)
JiHee HongSungwon Jung
Keimyung Author(s)
Hong, Ji HeeJung, Sung Won
Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학)
Dept. of Psychiatry (정신건강의학)
Journal Title
Pain Physician
Issued Date
2016
Volume
19
Issue
7
Keyword
Thoracic epidural anesthesiaintermittent epidural administrationoptimal volumeepidurographycephaladcaudadanalgesic effect
Abstract
Background: Thoracic epidural anesthesia (TEA) is frequently used to maintain intraoperative
analgesia. After injecting the initial bolus dose of epidural local anesthetics (LA), intermittent
injection of LA through an epidural catheter is required to maintain the intraoperative analgesia.
For intermittent epidural administration, usually 2 – 5 mL of LA has been used. However, no studies
have suggested an optimal volume of LA of TEA for intermittent epidural administration of TEA.
Objective: We focused on identifying an optimal volume of LA of TEA using epidurography of
the thoracic level with 2 different volumes of contrast dye.
Study Design: Prospective, randomized study.
Setting: An interventional pain management practice in South Korea.
Methods: After Institutional Review Board approval, 70 patients undergoing thoracic epidural
catheterization for upper abdominal and thoracic surgery were randomly assigned to one of the
2 contrast dye volume groups of 35 patients each (A, 2.5 mL and B, 5.0 mL). Epidurography was
evaluated to confirm how many spinal segments were covered by contrast dye. The spreads in the
cephalad and caudad directions were also evaluated.
Results: The total number of vertebral segments evaluated by contrast dye were 7.5 ± 2.0, and
8.4 ± 2.6, respectively in groups A and B. The number of patients who showed contrast dye spread
of more than 5 vertebral segments was 34/35 (97%) in both groups. Group B resulted in higher
contrast dye distribution in the cephalad direction compared to group A (T2.6 vs. T3.6 ).
Limitations: We used a test dose of contrast dye to confirm the contrast was in epidural space,
not intrathecal or vascular, before injection of the main dose of contrast dye. The present study did
not include the volume of test dose.
Conclusion: The volume of 2.5 mL for intermittent epidural administration would be enough
for the analgesic effect of upper abdominal and thoracic surgery while avoiding excessive upper
thoracic and cervical spread.
Keimyung Author(s)(Kor)
홍지희
정성원
Publisher
School of Medicine
Citation
JiHee Hong and Sungwon Jung. (2016). Fluoroscopically Guided Thoracic Interlaminar Epidural Injection: A Comparative Epidurography Study Using 2.5 mL and 5 mL of Contrast Dye. Pain Physician, 19(7), e1013–e1018.
Type
Article
ISSN
2150-1149
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32547
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Anesthesiology & Pain Medicine (마취통증의학)
1. School of Medicine (의과대학) > Dept. of Psychiatry (정신건강의학)
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