Abstract
A 23-year-old primigravid patient who received epidural analgesia for pain of labour presented with persistent, apparently irremediable, unilateral analgesia. Computerized axial tomo-epidurography demonstrated absence of circumferential spread due to lateral placement of the catheter. Transforaminal escape of contrast medium into the paravertebral area had occurred and anterior and posterior midline partitioning of the epidural space was obvious. All the usual measures to the promote contralateral analgesia, except reinsertion of the catheter, had been tried without success.
Résumé
Une primipare de 23 ans ayant reçu une analgésie par voie épidurale lors de l’accouchement a accusé une analgésie unilatérale persistanle et irrémédiable. Une tomoepidurographie axiale “computarisée” a démontré que l’absence d’extension circonferentielle de l’analgésie était due à une localisation latérale du cathéter, Une fuite du produit de contraste à travers le foramen vers la région paravertebrale est survenue expliquant la partition de l’espace épidural. Toutes les mesures habituelles pour remedier a cette situation furent essayees sans succes a l’exception de la ré-insertion du cathéter.
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References
Usubiaga JE, Dos Reis A, Usubiaga LE. Epidural misplacement of catheters and mechanisms of unilateral blockade. Anesthesiology 1970; 32: 158–61.
Singh A. Unilateral epidural analgesia. Anaesthesia 1967; 22: 147–8.
Shanks CA. Four cases of unilateral epidural analgesia. Br J Anaesth 1968; 40: 999–1002.
Ducrow M. The occurrence of unblocked segments during continuous lumbar epidural analgesia for pain relief in labour. Br J Anaesth 1971; 43: 1172–4.
Savolaine ER, Pandya JB, Greenblatt SH, Conover SR. Anatomy of the human lumbar epidural space: a new insight using CT-epidurography. Anesthesiology 1988; 68: 217–20.
Usubiaga JE, Wikinski JA, Usubiaga LE. Epidural pressure and its relation to the spread of anesthetic solutions in epidural space. Anesth Analg 1967; 46: 440–4.
Husemeyer BP, White DC. Topography of the lumbar epidural space. A study in cadavers using injected polyester resin. Anaesthesia 1980; 35: 7–11.
Doughty A. A precise method of cannulating the lumbar epidural space. Anaesthesia 1974; 29: 63–5.
Sanchez R, Acuna L, Rocha F. An analysis of the radiological visualization of the catheters placed in the epidural space. Br J Anaesth 1967; 39: 485–9.
Hehre FW, Sayig JM, Louman RM. Etiological aspects of failure of continuous lumbar peridural anesthesia. Anesth Analg 1960; 39: 511–4.
Narang VPS, Linter SPK. Failure of extradural blockade in obstetrics. A new hypothesis. Br J Anaesth 1988; 60: 402–4.
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Boezaart, A.P. Computerized axial tomo-epidurographic and radiographic documentation of unilateral epidural analgesia. Can J Anaesth 36, 697–700 (1989). https://doi.org/10.1007/BF03005424
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DOI: https://doi.org/10.1007/BF03005424