Adhesions in the epidural space caused by frequent epidural blocks

Shimada, N; Igarashi, Takashi; Murai, Kunihiko; Hara, Tetsuhito; Kuramochi, Tomoko; Takeuchi, Mamoru

doi:10.1186/s40981-017-0128-z

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Parturients with previous epidural experience had a higher failure rate than those who received EA for the rst time. A previous study has reported signi cant in ammatory changes and adhesions using the epidural scope in patients with a history of EA [20,21]. Puncture of the ava ligament and epidural catheterization lead to congestion and adhesions in the epidural space, resulting in disturbance in the local anesthetic spread in the epidural space [22].…”

Section: Discussionmentioning

confidence: 97%

Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study

Chao

Cheng

et al. 2023

Preprint

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Background: Epidural anesthesia (EA) is the preferred regional anesthesia technique in pregnant women who require cesarean section for delivery. Failure of EA requires additional sedation or convert it into general anesthesia (GA). It may be hazardous during sedation or GA conversion due to a potentially difficult airway. Therefore, this retrospective study aimed to determine the risk factors for epidural failure during cesarean section anesthesia. Methods: We retrospectively analyzed parturients who underwent cesarean section under EA and catheterization at Chang Gung Memorial Hospital in Taiwan between January 1 and December 31, 2018. Patient data were collected from medical records. EA failure was defined as the administration of any intravenous anesthetic at any time during the cesarean section, converting it into GA or even tube GA. Results: A total of 534 parturients who underwent cesarean section were recruited for this study. Of these, 94 (17.6%) parturients experienced failure of EA during the cesarean section. Compared to the patients with successful EA, those with EA failure were younger (33.0 years vs. 34.7 years) and have received EA previously (60.6% vs. 37%), were parous (72.3% vs. 55%), and had a shorter waiting time (14.9 mins vs. 16.5 mins) (p < 0.05). Younger age (OR 0.91, 95% CI 0.86–0.95), history of epidural analgesia (OR 2.61, 95% CI 1.38–4.94), and shorter waiting time (OR 0.91, 95% CI 0.87–0.97) were estimated to be significantly associated with a higher risk of epidural anesthesia failure. Conclusion: The retrospective study found that parturients with younger age, previous epidural catheterization history, and inadequate waiting time may have a higher risk of EA failure. Previous epidural catheterization increases the risk of EA failure by 2.6-folds compared to those with no catheterization history.

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Section: Discussionmentioning

confidence: 97%

Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study

Chao

Cheng

et al. 2023

Preprint

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“…The difference operation time between the 2 procedures were attributed to the distinct nature of both surgical procedures, such as patient-specific factors, equipment used, or the skill and experience of the surgeon. [41][42][43] With miniaturized endoscopic tools, the operation can provide a clearer visualization and potentially decrease postoperative complications due to reduced tissue trauma. However, there's a trade-off that smaller instruments may require more precise handling, meticulous maneuvers, and sometimes multiple instrument changes to achieve the desired outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, the operation time is longer compared to the MLD procedure. The difference operation time between the 2 procedures were attributed to the distinct nature of both surgical procedures, such as patient-specific factors, equipment used, or the skill and experience of the surgeon [ 41 - 43 ]. With miniaturized endoscopic tools, the operation can provide a clearer visualization and potentially decrease postoperative complications due to reduced tissue trauma.…”

Section: Discussionmentioning

confidence: 99%

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

Liu,

Kim,

Park

et al. 2023

Neurospine

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Objective: A preliminary report from a single institution, noninferiority, prospective randomized controlled trial is conducted to determine the effectiveness of interlaminar endoscopic lumbar discectomy (IELD) versus microscopic lumbar discectomy (MLD) for the treatment of L5–S1 lumbar disc herniation (LDH).Methods: This prospective, noncrossover, randomized controlled trials was conducted at a single neurosurgical center. Patients with symptomatic radiculopathy or intermittent neurogenic claudication caused by LDH were enrolled from July 2016 to July 2021. The study compared the effectiveness of microscopic and full-endoscopic discectomy procedures. Outcome measures included visual analogue scale (VAS) scores for back and leg pain, Oswestry Disability Index scores, radiologic measurements, endurance time of walking, and satisfaction rate.Results: Of 37 assessed patients, both IELD and MLD groups demonstrated significant improvements in VAS scores for pain over time, with no significant difference between them. For secondary outcomes, the IELD group had a shorter hospital stay and reduced blood loss but a longer operation time than the MLD group. Radiographic evaluations showed no change compared to preoperative data. Patient satisfaction and recovery rates were slightly higher for the MLD group, but both groups were comparable in most evaluations, with complications being minimal.Conclusion: The IELD was noninferior in improving the intensity of back and leg pain and functional disability, compared to the MLD. Additionally, the IELD showed no difference in clinical outcomes for patients in terms of radiographic results and patient satisfaction rates. The results of this research preliminarily demonstrate that the IELD could be considered an effective alternative to MLD for L5–S1 central or paracentral LDH.

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“…14 Shi-mada et al, also suggested that local inflammation caused adhesion in the epidural space. 15 Because the lumbar nerve as well as the dural sac in the spinal canal requires adequate mobility and spaces, the environment around the EFT and dural sac needs to be in a low-inflammatory condition to prevent adhesion.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Fujita et al reported that EFT in lipomatosis patients had significantly increased expression of inflammatory cytokines which are related to chronic inflammation in the spinal canal 14 . Shi- mada et al , also suggested that local inflammation caused adhesion in the epidural space 15 . Because the lumbar nerve as well as the dural sac in the spinal canal requires adequate mobility and spaces, the environment around the EFT and dural sac needs to be in a low-inflammatory condition to prevent adhesion.…”

Section: Discussionmentioning

confidence: 99%

Epidural Fat Tissue Is More Effective for Scar Prevention Than Conventional Subcutaneous Fat Grafting After Laminectomy in a Mouse Model

Hata

Kobayakawa

Saiwai

et al. 2021

Spine

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Study Design. Basic science study.Objective. The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation. Summary of Background Data. Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted.As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention. Methods. We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10 th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At 6 weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT.Results. The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was signifi-cantly higher in SFT than in EFT. At 6 weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT. Conclusion. EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.

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Adhesions in the epidural space caused by frequent epidural blocks

Cited by 6 publications

References 7 publications

Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study

Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

Epidural Fat Tissue Is More Effective for Scar Prevention Than Conventional Subcutaneous Fat Grafting After Laminectomy in a Mouse Model

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