Epidural distribution of dye administered via an epidural catheter in a porcine model.

BACKGROUND: Local anaesthetics are commonly delivered to the epidural space by either intermittent bolus or continuous infusion. While these methods have been investigated in terms of analgesia and total dose administered, they have not been compared in terms of their effect on the spread of injectate within the epidural space. This animal study compared the spread of dye delivered to the epidural space in a porcine model by either bolus or infusion. METHODS: After ethical approval, epidural catheters were placed at three vertebral levels in seven anaesthetized pigs. Aqueous dye (1 ml) was injected into the catheter as a bolus, or as an infusion over 30 min. Animals were euthanized at the end of the study and necropsy performed immediately to quantify the extent of dye spread. RESULTS: In seven animals, 20 catheters were successfully placed in the epidural space. The mean (sd) extent of dye spread was 8.9 (2.6) cm in the infusion group compared with 15.2 (2.7) cm in the bolus group (P<0.001). Segmental spread was significantly greater in the bolus group compared with the infusion group (P<0.01). CONCLUSION: In the porcine epidural model, spread of one ml of epidural dye solution is more extensive after a single bolus compared with short term infusion.

Peterborough Hospital at Home scheme.

The Peterborough Hospital at Home Scheme had explored the possibilities of treating at home patients who, if it were not for the scheme, would be in hospital. The scheme has been enthusiastically received by patients, consultants, general practitioners, nurses, and other health care workers. It is difficult to compare costs. Nevertheless, the cost of Hospital at Home care cannot be regarded as too expensive compared with care in hospital. Establishment of such schemes elsewhere would affect future allocation of capital.