Repeated failure of epidural analgesia: An association with epidural fat?☆

Lang, Scott A.; Korzeniewski, Peter; Buie, Donald; Plessis, Stephan du; Paterson, Kimiko; Morris, Gary

doi:10.1053/rapm.2002.34323

Cited by 18 publications

(16 citation statements)

References 57 publications

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“…SEL has rarely been reported in the cervical region. 23,25 In our first case, the lipomatosis was seen from T2 to T12, with greatest accumulation from T4 to T9. In the second case, the excessive adipose tissue was present from T5 to T9, with greatest accumulation at the level of T7 to T8.…”

Section: Discussionmentioning

confidence: 61%

Myeloneuropathic Presentation of Spinal Epidural Lipomatosis

Izadyar

Kwan²,

Harati³

2006

Journal of Clinical Neuromuscular Disease

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Spinal epidural lipomatosis (SEL) is accumulation of unencapsulated fat tissue within the epidural space of the spinal canal. The most common cause of SEL is corticosteroid therapy, whereas most of the non-corticosteroid-dependent cases are idiopathic. If unrecognized, it may result in diagnostic confusion with other neuropathic or myelopathic conditions. We report 2 cases of SEL. The first case is of a 30-year-old man who received corticosteroid therapy for an acute and probably immune-mediated demyelinating process. Subsequently, the addition of compressive effects of SEL resulted in diagnostic confusion and initial workup at other centers for spinal cord malignancy and vascular malformation. The patient's symptoms improved after decompression surgery. The second case is of a 63-year-old woman with a history of type 1 diabetes mellitus that presented with increasing numbness in the lower extremities. She was initially diagnosed with diabetic neuropathy; however, the presence of myelopathic signs led to further investigation and diagnosis of SEL. Decompression surgery resulted in improvement of symptoms.

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Section: Discussionmentioning

confidence: 61%

Myeloneuropathic Presentation of Spinal Epidural Lipomatosis

Izadyar

Kwan²,

Harati³

2006

Journal of Clinical Neuromuscular Disease

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“…Some evidence suggests that adipose tissue influences regional anesthesia (14). In a study conducted with magnetic resonance imaging, an increased posterior epidural fat volume correlated with a diminished degree of motor block and with a delayed onset time of motor and sensory block after epidural ropivacaine injection (15), whereas epidural repeatedly failed in a patient with epidural lipomatosis (16).…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine and levobupivacaine for bilateral selective ankle block in patients undergoing hallux valgus repair

Palmisani¹,

Arcioni²,

Benedetto³

et al. 2008

Acta Anaesthesiol Scand

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“…Epidural lipomatosis is an excess of epidural fat (Figure 7c,d) and has been linked to failure of analgesia [9]. This case report detailed a patient who had an elective small bowel resection with an L1/L2 epidural catheter for post-operative analgesia.…”

Section: Other Conditionsmentioning

confidence: 97%

Assessment of the spine with CT and MRI prior to interspinous/interlaminar spinal procedures: a pictorial review

Soh

Karmakar²

2013

BJR

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Imaging of the spine is increasingly available, whether as dedicated spine examinations or as studies that include the spine in the images obtained (e.g. CT abdomen). This pictorial review discusses imaging of the spine with CT and MRI and how prior review of this imaging can be helpful with potentially difficult spinal procedures. Pathologies illustrated include osteoarthritis, scoliosis, inflammatory spondyloarthropathies and post-operative spines.Many spinal procedures are performed using the interspinous (midline) or interlaminar (paramedian) approach with high success rates. These procedures include myelograms for diagnosis, epidural corticosteroid injections for pain relief, central neuraxial blocks in regional anaesthesia and lumbar punctures for cerebrospinal fluid (CSF) analysis. The causes for difficult spinal procedures are wide in range and include pathological/ anatomical conditions of the spine. As with all imaging as a whole, spinal imaging is increasingly more available with each individual patient [1], and review of such imaging can be helpful for difficult procedures.This pictorial review will discuss imaging (CT, MRI) of spinal conditions that can contribute to difficult spinal procedures, in particular osteoarthritis, scoliosis and the inflammatory spondyloarthropathies. The illustrations will focus on the

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Repeated failure of epidural analgesia: An association with epidural fat?☆

Abstract: We have described a case of repeated failure of epidural analgesia in a patient with epidural lipomatosis.

Cited by 18 publications

References 57 publications

Myeloneuropathic Presentation of Spinal Epidural Lipomatosis

Myeloneuropathic Presentation of Spinal Epidural Lipomatosis

Ropivacaine and levobupivacaine for bilateral selective ankle block in patients undergoing hallux valgus repair

Assessment of the spine with CT and MRI prior to interspinous/interlaminar spinal procedures: a pictorial review

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