Is intentional unilateral epidural catheterization reliable on pain management?

Efeitos da inclinação de agulha peridural e diferentes velocidades de injeção na distribuição de anestesia peridural

“…Borghi et al were able to place the catheter appropriately by turning the needle's extremity 45° towards the limb to be operated after advancing the tip of the epidural needle in the midline; this method revealed significant differences in terms of the motor and sensorial blocks between the operative and non-operative sides 5 . Dikmen et al were able to place the epidural catheter for post-operative analgesic purposes as described by Buchheit et al 4 , and demonstrated that the total morphine consumption and urinary retention were lower when using unilateral epidural block 6 .…”

“…Nonetheless, obtaining a preferential distribution of the epidural block towards the operative side is useful, especially when large doses of analgesics are required postoperatively to tolerate aggressive physiotherapy [1][2][3][4][5][6][7] . By evaluating the epidural catheter tip position and distribution of the injected solution by computed tomography (CT), Hogan [1][2][3][4][5][6][7] clearly demonstrated that most epidural catheter tips are placed in an anterior or lateral position. This results in great variability in the distribution of the local anesthetic solution.…”

“…This results in great variability in the distribution of the local anesthetic solution. Introducing the epidural needle at an angle from the midline and rotating it towards the operative side has been proposed to direct the epidural catheter towards the operative side 6 , and various reports have supported the clinical efficacy of such an intentional 'unilateral epidural block' [6][7][8][9][10] .…”