Continuous cervical epidural analgesia in metastatic spinal cord compression

Menon, Mahesh; Taha, Nafisa; Purohit, Navita; Kothari, Vatsal; Singh, Sukhbir

doi:10.4103/0973-1075.191860

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…In contrast to previous concerns about CEA challenges, new studies indicate that it is a safe and valuable substitute, especially for neck, breast, and upper limb procedures [ 8 , 10 - 12 ]. The successful application of CEA in situations such as the one described in this study, where it produced ideal surgical conditions, has been made possible by this shift in attitude.…”

Section: Discussionmentioning

confidence: 99%

Cervical Epidural Anesthesia in the Management of a Patient With Breast Cancer With Cardiac Dysfunction: A Case Report

Paul,

Singam,

Bhalerao

et al. 2024

Cureus

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As one of the most common cancers in the world, breast cancer management is fraught with difficulties. Modified radical mastectomy (MRM) is one of the surgical procedures that is essential to the treatment of breast cancer. Cardiovascular issues, especially a reduced ejection fraction (EF), make these procedures more complex. Due to their increased vulnerability to adverse cardiac events during surgery, it is imperative to preserve hemodynamic stability and reduce physiological stress responses in these patients. A promising option in this changing field of anesthetic techniques is cervical epidural anesthesia (CEA). It effectively reduces hemodynamic fluctuations frequently linked to general anesthesia while providing analgesia. We report the case of an elderly patient with decreased EF and breast cancer scheduled for an MRM. To ensure the best possible outcomes in complex cases, the case report covers preoperative assessment, anesthesia technique, intraoperative management, and postoperative outcomes. This highlights the critical significance of customizing anesthesia and surgical procedures, informed consent, and meticulous postoperative pain management, and ultimately advocates for the broader implementation of CEA in such settings.

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Section: Discussionmentioning

confidence: 99%

Cervical Epidural Anesthesia in the Management of a Patient With Breast Cancer With Cardiac Dysfunction: A Case Report

Paul,

Singam,

Bhalerao

et al. 2024

Cureus

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“…Most epidural analgesia procedures are performed with a catheter inserted in the lower thoracic or lumbar spine areas and then advanced in the cephalad direction ( 13 ). A previous case report described a patient with metastatic spinal cord compression who received cervical epidural analgesia due to neck pain ( 14 ). Furthermore, thoracic epidural analgesia was performed in patients during chest or abdominal surgeries or with rib fractures ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Upper thoracic spine puncture and caudal advance of an epidural catheter for adequate analgesia in a patient with breast cancer with chest and upper back pain: A case report

Zhong

Yang

et al. 2023

Exp Ther Med

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Patients with advanced cancer and metastasis frequently require analgesic treatments to relieve pain and maintain an acceptable quality of life. Continuous analgesic treatment with epidural drug infusion is one interventional approach to provide adequate pain relief. Most epidural analgesia procedures are performed with the catheter inserted in the lower thoracic or lumbar spine areas, which is then advanced in a cephalad direction to reach the level that requires analgesia. The present study reported on a patient with chest and upper back pain who failed oral oxycodone treatment. Epidural analgesia to target the T5 level was planned. However, a lower spinal puncture with cephalad advance of the catheter was not possible due to metastasis and compression in the T5-8 levels. Thoracic spine puncture was performed between the T1 and T2 vertebrae and the infusion catheter was advanced in a caudal direction to reach the T5 level. Successful pain relief and amelioration of clinical symptoms demonstrated that the method may be considered a feasible and safe approach to achieve adequate analgesia and improve the quality of life of patients with similar conditions.

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“…Continuous cervical epidural block desensitizes the cervical spinal cord to the stimuli, prevents sensitization, and breaks the cycle. [ 15 ] Boulouffe and Vanpee [ 16 ] reported that administration of local anesthetics blocks the calcium channel, decreases cellular neuronal excitement, and eventually stops hiccups. In our study, the decrease in time until the hiccups stopped, and the decrease in duration of maintaining the catheter could be explained by the inhibition of the cycle and stabilization of the nervous system by the continuous epidural block.…”

Section: Discussionmentioning

confidence: 99%

Continuous cervical epidural block

Kim

Lee

et al. 2018

Medicine

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Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown. This study aimed to evaluate the effectiveness of continuous cervical epidural block in the treatment of intractable hiccups.Records from 28 patients with a history of unsuccessful medical and invasive treatments for hiccups were evaluated. Continuous cervical epidural block was performed with a midline approach at the C7–T1 or T1–T2 intervertebral space with the patient in the prone position. The epidural catheter was advanced through the needle in a cephalad direction to the C3–C5 level. Catheter placement was confirmed using contrast radiography. A 6-mL bolus of 0.25% ropivacaine was injected, and a continuous infusion of 4 mL/h of ropivacaine was administered through the epidural catheter using an infuser containing 0.75% ropivacaine (45 mL ropivacaine and 230 mL normal saline). When the hiccups stopped and did not recur for 48 hours, the catheter was removed.Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third. One patient complained of dizziness that subsided. No other adverse effects were reported.Continuous C3–C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.

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Continuous cervical epidural analgesia in metastatic spinal cord compression

Cited by 4 publications

References 20 publications

Cervical Epidural Anesthesia in the Management of a Patient With Breast Cancer With Cardiac Dysfunction: A Case Report

Cervical Epidural Anesthesia in the Management of a Patient With Breast Cancer With Cardiac Dysfunction: A Case Report

Upper thoracic spine puncture and caudal advance of an epidural catheter for adequate analgesia in a patient with breast cancer with chest and upper back pain: A case report

Continuous cervical epidural block

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