Dural Puncture with a 26-Gauge Spinal Needle Affects Spread of Epidural Anesthesia

Suzuki, Nobuaki; Koganemaru, Mikako; Onizuka, Shin; Takasaki, Mayumi

doi:10.1213/00000539-199605000-00028

Cited by 11 publications

(16 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early in vitro and non‐obstetric studies suggest a possible transfer of epidurally injected solutions into the cerebrospinal fluid (CSF) through the dural hole created during the CSE technique with an improvement in epidural analgesia quality [33, 34]. The benefit of the ‘dural puncture epidural’ technique – whereby a dural hole is made with a spinal needle but the anaesthetic solution is injected only in the epidural space and not in the CSF – has been recently investigated during labour.…”

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

View full text Add to dashboard Cite

SummarySeveral strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is rapidly evolving, this review is an update, from a clinical point of view, of developments over the last 5-7 years. We discuss advantages and controversies related to combined spinal-epidural analgesia, patient controlled epidural analgesia and the integration of computer systems into analgesic modalities. We also review the recent literature on future clinical and research perspectives including ultrasound guided neuraxial block placement, epidural adjuvants and pharmacogenetics. We finally look at the latest work with regards to epidural analgesia and breastfeeding. Several strategies and alternative therapies have been used to provide analgesia for one of women's most painful experiences in life, labour pain. These include non-pharmacological approaches such as hypnosis, acupuncture, hydrotherapy and transcutaneous electrical nerve stimulation as well as the administration of nitrous oxide and low-dose sevoflurane and parenteral opioids. Although some of these therapies provide satisfactory pain relief from the mothers' point of view [1,2], there is evidence that neuraxial local anaesthetics and opioids yield superior and more reliable analgesia than these aforementioned methods [3,4].Although invasive, neuraxial labour analgesia is considered safe practice. Over the last decade, several improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. These developments include the introduction of combined spinal-epidural (CSE) analgesia, 'mobile epidurals', patient controlled epidural analgesia (PCEA), computer assisted injection of epidural solutions and ultrasound guided neuraxial techniques. Some of these advances have already been introduced into clinical practice while ongoing research is stimulated by the exciting clinical perspectives brought forward by other developments. This review focuses on the recent advances in neuraxial labour analgesia and on the relevant scientific literature published in the last 5 years. We performed a MEDLINE-based search of all the literature published from January 2005, using the following keywords: labour analgesia; epidural; spinal; combined spinal-epidural; pregnancy; obstetric; neostigmine; clonidine; pharmacogenetics; and breastfeeding. We focussed our research on prospective, randomised controlled trials as well as meta-analysis and further completed our review by including retrospective observational trials and case reports where relevant. For clarity of discussion and when considered necessary, we also included literature from earlier years. Initiating neuraxial analgesiaUltrasound guided neuraxial techniques Ultrasound i...

show abstract

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Obstetric anaesthesia and analgesia have generated most reports of the technique. It is regarded by some as the optimum regional technique for nonobstetric surgery [12] and has been used for orthopaedic [12], trauma [13], general [14], vascular [15] and gynaecological surgery [16]. It has also been used for paediatric anaesthesia [17].…”

Section: Applications Of Cse Techniquesmentioning

confidence: 99%

“…Suzuki et al . found that dural puncture per se (without drug injection) altered the dermatomal distribution of subsequent epidural blockade [16]. The extent of caudal block was increased with no change in the cephalad spread.…”

Section: Cse As a Multicompartment Block: Effects Of Prior Dural Puncmentioning

confidence: 99%

“…Suzuki et al . found dural puncture with a fine needle without drug injection enhanced caudal spread of blockade with no change in cephalad spread [16], which suggests the pharmacological effect of epidural injection is largely due to action in the epidural space rather than from drug flux through the dural puncture site.…”

Section: Cse As a Multicompartment Block: Effects Of Prior Dural Puncmentioning

confidence: 99%

“…It should be assumed that small amounts of epidurally administered drugs will enter the subarachnoid space and solutions with preservatives or other agents considered unsafe for intrathecal administration should not be used. In addition, it is possible that spread of drug to the sacral region may be increased [16]. High doses of local anaesthetic should probably be avoided.…”

Section: Safety Aspectsmentioning

confidence: 99%

See 2 more Smart Citations

Combined spinal–epidural techniques

Cook

2000

Anaesthesia

161

View full text Add to dashboard Cite

SummaryThe combined spinal-epidural technique has been used increasingly over the last decade. Combined spinal-epidural may achieve rapid onset, profound regional blockade with the facility to modify or prolong the block. A variety of techniques and devices have been proposed. The technique cannot be considered simply as an isolated spinal block followed by an isolated epidural block as combining the techniques may alter each block. This review concentrates on technical and procedural aspects of combined spinal-epidural. Needle-through-needle, separate-needle and combined-needle techniques are described and modifications discussed. Failure rates and causes are reviewed. The problems of performing a spinal block before epidural blockade (potential for unrecognised placement of an epidural catheter, inability to detect paraesthesia during epidural placement, difficulty in testing the epidural, delay in positioning the patient) are described and evaluated. Problems of performing spinal block after epidural blockade (risk of catheter or spinal needle damage) are considered. Mechanisms of modification of spinal blockade by subsequent epidural drug administration are discussed. The combined spinal-epidural technique (CSE) involves intentional subarachnoid blockade and epidural catheter placement during the same procedure. CSE allows a rapid onset of neuraxial blockade, which can subsequently be prolonged or modified. Ideally it combines the best features of spinal blockade (rapid onset, profound blockade, low drug dosage) and epidural blockade (titratable levels, ability to prolong indefinitely) and avoids their respective disadvantages (spinal: single-shot nature, unpredictable level of blockade; epidural: missed segments, incomplete motor block, poor sacral spread, local anaesthetic toxicity). However, it is a more complicated technique than either block alone and produces a multicompartment block. This introduces the potential for new complications and the modification of existing complications. CSE cannot be considered as simply a spinal block followed by an epidural block. A variety of techniques, equipment and regimens have been described. New complications and reasons for technical failure are encountered. Epidural injection may modify the spinal block and epidural drugs may not behave as they would without prior dural puncture. Review aims and methodThis review examines the current literature on technical aspects of the CSE technique and factors that distinguish it from either spinal or epidural blockade. The review does not consider different drug regimens or address the role of the technique as analgesia during labour. Owing to the limited number of randomised controlled trials and other high-quality research, the review is descriptive. Articles were found by Medline search through the years 1975-1999 using the search words 'spinal' or 'subarachnoid' and 'epidural' or 'extradural'. Reference lists in these publications were searched. The major anaesthetic journals were hand searched. This search identified 5...

show abstract

Motor block during patient-controlledepidural analgesia with ropivacaine or ropivacaine/fentanyl afterintrathecal bupivacaine for Caesareansection †

Buggy

Hall

Shah

et al. 2000

British Journal of Anaesthesia

View full text Add to dashboard Cite

We compared patient-controlled epidural analgesia (PCEA) with ropivacaine alone or combined with fentanyl in terms of analgesic efficacy, motor weakness and side-effects in patients who had received spinal anaesthesia for elective Caesarean section. ASA I patients received combined spinal-epidural anaesthesia and were randomly assigned, in a double-blind study, into two groups after operation: group R (n = 23) received PCEA ropivacaine 0.1%, bolus 5 mg, lock-out 15 min, 3 mg h-1 background infusion, and group RF (n = 24) received PCEA 0.1% ropivacaine/fentanyl 2 micrograms ml-1 at identical settings. Pain and satisfaction on a 100 mm visual analogue scale (VAS) and side-effects were noted. Incidence of motor weakness (Bromage grade 1 or higher) was 48% (11/23) at 8 h in group R compared with 13% (3/24) in group RF (P = 0.025). Pain scores on movement were lower in group RF at 8 and 12 h and at rest at 6 and 8 h (P < 0.05 for each comparison). Analgesic consumption was less in RF (P = 0.041), but there was no difference in time to first request for supplementary analgesia. Patient satisfaction with postoperative analgesia (mean (SD)) was higher in RF (79 (23) vs 57 (29) mm, P = 0.045). Caution should be exercised using ropivacaine PCEA after spinal bupivacaine for Caesarean section, because its reputed motor-sparing property may be unreliable.

show abstract

Dural Puncture with a 26-Gauge Spinal Needle Affects Spread of Epidural Anesthesia

Cited by 11 publications

References 6 publications

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Combined spinal–epidural techniques

Motor block during patient-controlledepidural analgesia with ropivacaine or ropivacaine/fentanyl afterintrathecal bupivacaine for Caesareansection †

Contact Info

Product

Resources

About