Anesthetic effect of epidural anesthesia with cephalad or caudad catheterization for ankle surgery or hemorrhoidectomy

Chou, Wen-Ying; Hsu, Chiung-Dan; Cheng, Jiin‐Tsuey; Yang, Liling; Lin, Chung Ren; Chia, Yuan-Yi; Yu, Soojie; Tan, Ping-Heng

doi:10.1111/j.1399-6576.2005.00620.x

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…However, the BKA patients had similar opioid consumption in both groups. Lumbar epidural analgesia may not cover sacral neural roots, especially root S1, in a sufficient manner, which may explain this issue . Based on the insufficient sacral spread of epidural analgesia and the present results suggesting higher need of opioid medication in the GA group in AKA, we can hypothesise that SA could be superior to GA in AKA.…”

Section: Discussionmentioning

confidence: 63%

Spinal or general anaesthesia for lower‐limb amputation in peripheral artery disease – a retrospective cohort study

Niskakangas

Dahlbacka

Liisanantti

et al. 2017

Acta Anaesthesiol Scand

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Patients with spinal anaesthesia had a lower rate of surgical complications, re-operations and intensive care unit admissions. Patients with above-the-knee amputation and spinal anaesthesia had a lesser need for opioid medication in the post-operative period than patients with general anaesthesia. Anaesthesiologists performed neuraxial anaesthesia and/or analgesia in high-risk patients despite abnormal coagulation profile or ongoing anticoagulation, but no adverse outcomes were reported.

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Section: Discussionmentioning

confidence: 63%

Spinal or general anaesthesia for lower‐limb amputation in peripheral artery disease – a retrospective cohort study

Niskakangas

Dahlbacka

Liisanantti

et al. 2017

Acta Anaesthesiol Scand

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“…However, another study showed that the injection of a local anaesthetic solution through a lumbar epidural catheter oriented caudally resulted in a faster onset and superior quality of anaesthesia in comparison with a cephalad-oriented catheter in ankle surgery (operating site innervated mainly by S1), but not in haemorrhoidectomy (by S3–5). 32 This interesting difference between the two aforementioned studies implies that although more anaesthetic pooled in the sacral area with the caudally oriented lumbar epidural catheter, sensory analgesia with a lumbar epidural block for the area innervated by the sacral nerve (excluding S1, the blockade of which is often delayed due to the larger size of this root 8 ) is not affected by the direction of spread of the local anaesthetic. 31 , 32 In this present study, it remains unclear as to whether the direction of the epidural catheter affected manometric changes within the LE group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study

et al. 2016

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ObjectiveTo compare the effects of saddle, lumbar epidural and caudal blocks on anal sphincter tone using anorectal manometry.MethodsPatients undergoing elective anorectal surgery with regional anaesthesia were divided randomly into three groups and received a saddle (SD), lumbar epidural (LE), or caudal (CD) block. Anorectal manometry was performed before and 30 min after each regional block. The degree of motor blockade of the anal sphincter was compared using the maximal resting pressure (MRP) and the maximal squeezing pressure (MSP).ResultsThe study analysis population consisted of 49 patients (SD group, n = 18; LE group, n = 16; CD group, n = 15). No significant differences were observed in the percentage inhibition of the MRP among the three regional anaesthetic groups. However, percentage inhibition of the MSP was significantly greater in the SD group (83.6 ± 13.7%) compared with the LE group (58.4 ± 19.8%) and the CD group (47.8 ± 16.9%). In all groups, MSP was reduced significantly more than MRP after each regional block.ConclusionsSaddle block was more effective than lumbar epidural or caudal block for depressing anal sphincter tone. No differences were detected between lumbar epidural and caudal blocks.

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“…The study was initiated to insert the epidural catheter toward the caudad direction rather than the cephalad direction, which is the conventional practice. Chou et al [2] compared the effects of catheter insertion in either the caudad or cephalad direction during the epidural anesthesia for the ankle surgery, considering the possibility of insufficient anesthesia at the S1 nerve root, with the thicker nerve root. It was reported that the group with insertion toward the caudad direction had a shorter time to reach anesthesia and had a better anesthetic effect.…”

Section: Discussionmentioning

confidence: 99%

“…Although a number of factors contribute to the extent of the nerve block in epidural anesthesia, some published reports state that it is better to insert the epidural catheter toward the caudad than the cephalad direction for effective sacral anesthesia [2]. As such the administration of local anesthesia through the epidural catheter inserted toward the caudad side may be the more effective anesthetic method in urological procedures such as transurethral resection.…”

Section: Introductionmentioning

confidence: 99%

Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

Kim

Lee

Kim

2013

Korean J Anesthesiol

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BackgroundContinuous epidural anesthesia is useful for endoscopic urologic surgery, as mostly performed in the elderly patients. In such a case, it is necessary to obtain successful sacral anesthesia, and the insertion of epidural catheter in the caudad direction may be needed. However, continuous epidural catherization has been related to paresthesias. This study aimed to evaluate the effects of the direction of the catheter insertion on the incidence of paresthesias in the elderly patients.MethodsTwo hundred elderly patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L2-3, L3-4, and L4-5 using the Tuohy needle. In Group I (n = 100), the Tuohy needle with the bevel directed the cephalad during the catheter insertion. In Group II (n = 100), it directed the caudad. During the catheter insertion, an anesthesiologist evaluated the presence of paresthesias and the ease or difficulty during the catheter insertion.ResultsIn Group I (n = 97), 15.5% of the patients had paresthesias versus 18.4% in Group II (n = 98), and there was no significant difference between the two groups. In paresthesia depending on the insertion site and the ease or difficulty during the catheter insertion, there were no significant differences between the two groups.ConclusionsOur results concluded that the direction of epidural catheter insertion did not significantly influence the incidence of paresthesias in the elderly patients.

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Anesthetic effect of epidural anesthesia with cephalad or caudad catheterization for ankle surgery or hemorrhoidectomy

Abstract: Injection of local anesthetic solution through a caudally oriented epidural catheter produces faster onset and superior quality of anesthesia in comparison with the injection through the cephaladly oriented catheter in ankle surgery, but not hemorrhoidectomy.

Cited by 6 publications

References 11 publications

Spinal or general anaesthesia for lower‐limb amputation in peripheral artery disease – a retrospective cohort study

Spinal or general anaesthesia for lower‐limb amputation in peripheral artery disease – a retrospective cohort study

Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study

Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

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