Showing 8 results for Epidural
Sheikh Rezaei A, Fakhr Tabatabaei Sa, Khoshnevisan A, Marzban H, Nikbakht M, Barbarestani M, Asadi F,
Volume 59, Issue 3 (6-2001)
Abstract
There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon) in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.
Sadeghi S A, Soleimani A A,
Volume 62, Issue 3 (6-2004)
Abstract
Background: Epidural injection of the drugs such as opioids has rather been a successful method in controlling post operative pain.
Materials and Methods: In a clinical trial study, 50 Female patients, in a range of 20-40 years old and ASA class I, who were scheduled for gynecologic operation were investigated. They were randomly divided in two groups. Before induction of general anesthesia, an epidural catheter was placed for each patient. Sixty minutes after the end of operation, a 15-ml solution containing 50-microgram clonidine was injected through the epidural catheter in the first group. In the second group, a similar volume solution containing 50- microgram fentanyl was injected. The catheter was removed after all the patients were followed for 4 hours and their pain was assessed by VAS (Visual Analogue Scale) method.
Results: Our findings revealed that the clonidine group had more intense pain however they had fewer complications than the opioid group.
Conclusion: We concluded that although clonidine might act as an analgesic drug, but epidural injection of a single dose of 50 microgram of the drug could not be effective enough for postoperative analgesia.
Talebpour M, Niazie M, Jafari Javid M,
Volume 65, Issue 1 (3-2008)
Abstract
Background: The incidence of inguinal hernia is 15 cases per 1,000 populations.
The most common surgical methods of hernia repair are conventional open hernioplasty and laparoscopic hernioplasty. The advantages of laparoscopic hernioplasty are that the regional anatomy is observable, and bilateral herniorrhaphy can be performed at the same time. Since laparoscopic hernia is usually performed under general anesthesia, to shorten the length of hospital stay and to prevent complications, in this study, we evaluated the use of epidural anesthesia during hernioplasty.
Methods: This study included 20 male patients treated by a single surgeon. We recorded the PCO2 levels before, during and after surgery, as well as the pain and intra-abdominal pressure.
Results: Only one patient required conversion to general anesthesia. Three patients had hernia on the left side only, 14 patients on the right only and three patients had bilateral hernia. The PCO2 levels did not change (P=0.789).
Fifty percent of patients had no postoperative pain. The median time to return to work or normal physical activity was 7 days.
Conclusion: Laparoscopic inguinal herniorrhaphy is a feasible alternative to open surgical hernia repair. Employing epidural anesthesia prevents the complications of general anesthesia. This method achieves a shorter hospital stay and time to return to normal activity, as well as reduction in pain. Controlled trials comparing laparoscopic and tension-free open herniorrhaphy are needed to further assess the relative benefits of this procedure.
Amiri H R, Makarem J,
Volume 66, Issue 2 (5-2008)
Abstract
Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable. Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.
Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.
Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.
H.r Amiri, J Makarem, S Beiranvand,
Volume 66, Issue 5 (8-2008)
Abstract
Background: post operative pain is an essential problem. Epidural infusion of two different doses of bupivacaine in pain management of post orthopedic surgeries was studied.
Methods: In this double blinded randomized clinical trial we studied two groups of 42 patients undergone knee surgery. Based on block randomization, patients received two different concentration of bupivacaine (0.1% or 0.125%) in combination with fentanyl (1.7µg/ml). The beginning infusion rate was 5ml/h. Pain scores were documented by a blinded researcher 6, 12, 18, 24 and 48 hours after completion of surgery according to VAS tool. Patient satisfaction, complications and treatment failure (when increased volume of epidural infusion or other analgesics were required) were evaluated.
Results: In higher bupivacaine dose group, post operative pain scores were not significantly lower in different hours and during the follow up (both p values less than 0.001). After 48 hours, patients satisfaction were more in the higher bupivacaine group. There were no significant differences in complications. Treatment failure was more significant in lower bupivacaine dose (33.3% versus 11.9%, p=0.03).
Conclusion: continuous epidural infusion of both bupivacaine and fentanyl provide acceptable post operative pain control in orthopedic patients. Although higher concentrations of bupivacaine during first hours are more effective, lower concentrations are as effective as the higher one, during subsequent hours.
Lotfinia I, Kallagee E, Mesgaree M, Esmaelee H,
Volume 66, Issue 11 (2-2009)
Abstract
Background: Epidural fibrosis (EF) is a part of normal physiological tissue response to laminectomy and it may be an important cause of failed back surgery syndrome (FBSS). The objective of this study was to evaluate the effect of using gel foam after laminectomy on reduction of epidural fibrosis.
Methods: In this prospective study forty five rabbits were recruited. The cases undergone bilateral laminectomy at the L4 and L5 lumbar levels under an approved surgical protocol. After eight weeks the rabbits were sacrificed and the spinal segments from L3 to L6 were removed en bloc. The amount of scar tissue at the laminectomy defect was scored. The fibroblast and inflammatory cell counts were also compared between two groups.
Results: In this study 55% of group A rabbits were placed in grade 0 or I, grade II fibrosis could be detected in the remaining 45%. In group B these amounts were 73.7% and 26.3% respectively, which no significant statistical difference could be detected between two arms (p=0.189). Comparing the quantity of fibroblasts 40% of group A rabbits were recognized as grade I and the other 60% as grade II and grade I fibrosis was discovered in 42.1% of group B rabbits, while other 57.9% suffered from grade II fibrosis, again no significant statistical difference could be attributed between two arms (p=0.576). Also comparing inflammatory cell counts detected in the specimens no significant statistical difference could be detected either (p=0.465).
Conclusion: According to this study using gel foam during the laminectomy surgery in rabbits has no obvious effect in reducing post laminectomy epidural fibrosis after eight weeks of follow-up.
Mohammadi M, Barkhordari Kh, Khajavi Mr,
Volume 68, Issue 4 (7-2010)
Abstract
Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous.
Case presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperativeepidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic.
Conclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.
Farhad Tavakoli, Ebrahim Espahbodi, Abbas Ostad Alipour ,
Volume 81, Issue 9 (12-2023)
Abstract
Background: CSF fluid leakage due to damage to the dura mater layer is a rare complication of spine surgery. One of the methods to control symptoms in case of failure of supportive treatments is to inject the patient's blood into the epidural space at the levels adjacent to the leakage site
Case Presentation: The patient is a 56-year-old woman, who suffered a CSF leak after laminectomy of the fourth vertebra. Due to the presence of a surgical incision at the leak site, the lack of access to the epidural space from that location, and disturbing symptoms, caudal space was chosen. Method, In a prone position with vital signs monitoring, proper sedation, and local anesthetic injection, in completely sterile conditions, with the help of fluoroscopy, through the sacral hiatus Tuohy 18G needle entered into the epidural space and contrast material was injected, the exact location of the needle in the AP-Lateral view ensured, the epidural catheter was measured from the skin to the approximate location of the L4 vertebra and about 20 cm of the catheter was shortened to facilitate blood injection then the catheter was inserted into the epidural space again, the contrast material was injected into the catheter and the diffusion of the contrast material was seen at the level of the fifth vertebra. Then, in the cubital vein, a 16G IV cannula was inserted under completely sterile conditions. Then 20 cc of blood was taken from the patient's peripheral vein and slowly injected into the catheter. After the injection of 17 cc, the patient felt heaviness and pain in the lower back, the blood injection was stopped and the catheter and needle were removed. The needle insertion site was bandaged and the patient with stable vital signs and full consciousness was transferred to the recovery room and then to the ward.
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Conclusion: when it is not possible to access the epidural space via the interlaminar approach, the caudal space by inserting a catheter can be a good alternative.
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