Korean J Pain.  2010 Dec;23(4):247-253. 10.3344/kjp.2010.23.4.247.

Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position

• Uchino T
• Hagiwara S
• Iwasaka H
• Kudo K
• Takatani J
• Mizutani A
• Miura M
• Noguchi T

• KMID: 1454708
• DOI: http://doi.org/10.3344/kjp.2010.23.4.247

Abstract

BACKGROUND
Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain.
METHODS
In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging.
RESULTS
The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery.
CONCLUSIONS
Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

Keyword

epidural anesthesia; iotrolan; pain; postoperative; radiography

MeSH Terms

Analgesia
Anesthesia
Anesthesia, Epidural
Anesthesia, General
Catheters
Catheters, Indwelling
Chronic Pain
Humans
Parturition
Spine
Thoracic Vertebrae
Triiodobenzoic Acids
Triiodobenzoic Acids