Horner's syndrome is a rare side effect of epidural analgesia. In association with ipsilateral brachial plexus block, it has only been reported once before, in French. Unilateral blockade has also been reported, although its etiology is unclear and may be multifactorial. The patient described here experienced an asymmetrical epidural blockade with a unilateral Horner's syndrome and ipsilateral ...

BACKGROUND The estimation of the distance from the skin to the thoracic epidural space or skin to epidural depth (SED) may increase the success rate and decrease the incidence of complications during placement of a thoracic epidural catheter. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine, allowing for the accurate determination of tissue spaces and dis...

Editor’s key points † Thoracic epidural analgesia is associated with rare but potentially serious complications. † In the setting of lung surgery single-shot intercostal block (ICB) offers an alternative modality of postoperative regional analgesia. † This study compared PCEA with single-shot ICB combined with PCA. ICB with PCA was not as effective as PCEA with respect to postoperative pain con...

·T WO factors have increased interest in ketamine for postoperative analgesia. The first was the discovery of the N-Methyl-D-aspartate (NMDA) receptor and its role in central pain processing and spinal cord neural plasticity.1 Ketamine is one of two clinically useful NMDA receptor antagonists available (the other is dextromethorphan). Ketarnine binds non-competitively to the PCI, (phencyclidine...

BACKGROUND Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risk...

EDITOR: Patients with hip fracture are often frail and elderly, and co-morbidities are frequently present. The following case describes perioperative use of continuous epidural blockade in a patient with hip fracture and a severe aortic stenosis. This has not been reported before. There is no evidence favouring general anaesthesia to neuroaxial blockade in patients with aortic stenosis. Several...

Background. The hanging drop (HD) technique presumably relies on the presence of subatmospheric epidural pressure. It is not clear whether this negative pressure is intrinsic or an artifact and how it is affected by body position. There are few data to indicate how often HD is currently being used. Methods. We identified studies that measured subatmospheric pressures and looked at the effect of...

Though once considered the gold standard, epidural anaesthesia has complications that may be significant and include hypotension, urinary retention, partial or patchy block and, in rare cases, devastating neurological injuries also. Paravertebral block (PVB) is an alternative technique for unilateral surgical procedures like thoracotomy, which may offer similar analgesic effectiveness and a mor...