Document Detail


Epidurograms in the management of patients with long-term epidural catheters.
MedLine Citation:
PMID:  8826026     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Standardized test doses have been established in the practice of anesthesiology to determine the location of the epidural catheter tip. The resulting data obtained after test dosing is open to interpretation, and comparison is difficult. A more objective method of catheter verification and epidural space measurement is indicated in long-term epidural catheterization. The goal of this review is to define a standard procedure for epidurography, explore the use of an epidurogram algorithm in differential diagnosis, and review the temporal relationship of a series of epidurograms. METHODS: A standard epidurogram procedure was defined and used for the study. Routine postoperative epidurograms were obtained following epidural catheter placement. Serial epidurograms were obtained when clinically indicated, as described in the epidurogram algorithm. Radiographs taken after injection of the dye were used for determination of epidural catheter tip location and volume dye flow. Two cases are presented to demonstrate the effectiveness of the epidurogram algorithm. RESULTS: Epidurograms show dye dispersion within the space, allowing for visualization of anomalies, resulting in a permanent record for later review. Case reports demonstrate the use of epidurograms in determining the cause of changes in epidural analgesia. CONCLUSIONS: The review of repeated epidurograms and presented case reports support the use of epidurograms as a diagnostic tool for clinical practice. Abnormal epidurograms helped determine epidural space infection, tumor obstruction, space compression from vertebral compression fractures, and epidural fibrosis. The addition of a contrast computed tomographic scan after epidurography allows for more accurate diagnostic interpretation of epidural space pathology. The use of a standard epidurogram technique allows this procedure to be used in the differential diagnosis of suspected problems in the epidural space.
Authors:
S L Du Pen; A R Williams; R K Feldman
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Regional anesthesia     Volume:  21     ISSN:  0146-521X     ISO Abbreviation:  Reg Anesth     Publication Date:    1996 Jan-Feb
Date Detail:
Created Date:  1996-12-04     Completed Date:  1996-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7707549     Medline TA:  Reg Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  61-7     Citation Subset:  IM    
Affiliation:
Tumor Institute Pain Service, Swedish Medical Center, Seattle, WA 98104, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Analgesia, Epidural*
Catheters, Indwelling*
Epidural Space / radiography*
Female
Humans

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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