When performing lumbar epidural steroid injection on obese patients, needle placement can be challenging due to the difficulty in estimating the appropriate needle length to utilize. Often times, the standard 3.5‐inch Tuohy needle is too short to reach its target. In our case report, a needle‐through‐needle technique was attempted in a lumbar interlaminar epidural steroid injection procedure after the initial needle fell short of the epidural space. To avoid removing the initial needle and restarting the procedure using a longer needle, a 20‐gauge 6‐inch Tuohy needle was inserted into the 17‐gauge 3.5‐inch Tuohy needle, successfully reaching the epidural space. This technique can facilitate quicker needle placement by avoiding the need for restarting the procedure with a longer needle. Thus, procedural time and radiation exposure may be decreased, as may patient discomfort from repeat needle insertions.
No abstract
Patients presenting for vascular surgery typically have significant comorbidities. Procedures can vary from minor to quite large with significant blood loss and fluid shifts, and can be elective or emergent. Perioperative morbidity and mortality in the context of co-existing cardiovascular disease, diabetes, dementia and other factors all provide great concern to the anesthesiologist in their approach towards the vascular patient. The anesthetic approach to such patients must therefore be taken with great forethought. Many times, these procedures can be localized to a particular extremity or well-defined set of dermatomes, and regional anesthesia has become one important option for the complicated vascular patient. In this chapter, the risks, benefits, and feasibility of various regional techniques are discussed in the context of patients presenting for carotid endarterectomy, vascular access placement, and major lower extremity vascular surgery.
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