Cephalic spreading levels after volumetric caudal epidural injections in chronic low back pain

The volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to the lesion site. This study was aimed to examine the actual spreading patterns of this technique, using epidurogram. A total of 32 patients with chronic low back pain accompanied by radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. The volumetric caudal epidural injection of the 10 mL mixture of contrast medium 5 mL, 0.5% bupivacaine 1 mL, triamcinolone 1.5 mL (60 mg) and normal saline 25 mL was performed. Immediately after the cessation of the first spread, the subsequent solution of another 10 mL of contrast medium 5 mL, 0.5% bupivacaine 1 mL and normal saline 4 mL was injected. This procedure was repeated serially until the total volume to be 50 mL. Continuous fluoroscopic imaging was obtained after each injection. Average time taken to complete the study was 37 sec per every 10 mL. The spreading levels of the mixture were distributed mainly at mid to lower lumbar area in the majority of the patients. During the subsequent injections, the levels were not changed significantly. This was thought to be due to the minimal resistance in cephalad direction, anatomic variations and Starling effect of epidural space.

A Study for Minimum Volumes of Bicarbonate to Cause Precipitation of the Domestic Lidocaines / 대한마취과학회지

BACKGROUND: When local anesthetics for regional anesthesia is used, usually small amounts of bicarbonate are added for rapid onset. This addition gives the mixed solution a more alkaline pH. The following result is an increased unionized form of the local anesthetic and rapid penetration of the drug into tissue. Unfortunately, no data about adequate mixing volumes of domestic lidocaine and bicarbonate is available. METHODS: We examined six mixing pairs of two kinds of 2% lidocaines and three kinds of 8.4% bicarbonates for minimum volumes of bicarbonate to cause a precipitation of 2% 20 ml lidocaine. RESULTS: The mean volumes of bicarbonate to cause precipitation were 1.54 ml for Kwang-Myung lidocaine with Kwang-Myung bicarbonate, 2.90 ml for Kwang-Myung lidocaine with Dae-Won bicarbonate, 2.73 ml for Kwang-Myung lidocaine with Je-Il bicarbonate, 0.97 ml for Je-Il lidocaine with Kwang-Myung bicarbonate, 1.26 ml for Je-Il lidocaine with Dae-Won bicarbonate and 1.39 ml for Je-Il lidocaine with Je-Il bicarbonate. CONCLSIONS: We conclude that the Kwang-Myung lidocaine and the Je-Il lidocaine could cause precipitation when mixing with a smaller bicarbonate volume than foreign textbook recommended.

Cauda Equina Syndrome Following Volumetric Caudal Epidural Steroid Injection in a Herniated Interverterbral Disc Patient: A case report / 대한마취과학회지

Volumetric caudal epidural injections of steroid have recently been done in patients with acute or chronic lumbago and sciatica. This method is easier way of sending steroid to the sacral nerve root than lumbar epidural injections. The Cauda equina syndrome is a rare complication of epidural pain block. We report on a case in which an emergency laminectomy was done because cauda equina syndrome occurred just after a volumetric caudal epidural steroid injection in a patient with a herniated interverterbral disc.

A Study of the Effects of Neuroplasty by Spinal Endoscopy in Herniated Nucleus Pulposus Patients for Therapeutic Purpose / 대한마취과학회지

BACKGROUND: Neuroplasty by spinal endoscopy is a new technique in the field of treatment of herniated nucleus pulposus patients. This new technique allows the operator to visualize directly the epidural space and contiguous structures, thus allowing for detailed examination leading to a better understanding of the role of epidural adhesion in the development of sciatica. The aim of this prospective study is to determine effects of neuroplasty by spinal endoscopy in herniated nucleus pulposus patients. METHODS: Twelve patients with herniated disc were taken neuroplasty by spinal endoscopy. The patients were followed with verbal rating scale(VRS) for 2 weeks, 3 months and 6 months after neuroplasty. RESULTS: Four patients were posterocentral type and eight pateints were posterlateral type. The effects of neuroplasty by spinal endoscopy in posterolateral type were significantly higher than that of posterocentral type. But, age, duration of back pain and amount of irrigation saline were not related to effects of neuroplasty by spinal endoscopy. CONCLUSIONS: We conclude that it is important to determine posterocentral type or posterolateral type on MRI before neuroplasty by spinal endoscopy and the effects of treatment is well in posterolateral type.