Transforaminal epidural steroid injections are provided frequently for patients with lumbar radiculopathy, having demonstrated efficacy and safety. We present a patient who developed methicillin-resistant Staphylococcus aureus epidural abscess 11 days after a transforaminal epidural steroid injection. The abscess required surgical intervention and intravenous vancomycin. Fortunately, the patien...

Subcutaneous emphysema and pneumomediastinum are well-known complications of barotrauma. There are no fascial barriers between the posterior mediastinum and the retropharyngeal and epidural spaces; thus, air can diffuse freely to the epidural space and produce an epidural pneumatosis. We report a case of epidural pneumatosis caused by a pneumomediastinum following nasotracheal intubation for an...

We report a case of adhesions in the epidural space caused by more than 200 times epidural blocks that were observed with epiduroscopy. A 41-year-old man had repeatedly undergone lumbar epidural blocks to treat pain in his leg, resulting in decreased efficacy of the epidural block. We described endoscopic findings that these adhesions were mostly consisted of adhesions formed from the soft conn...

Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a sp...

We report the case of a woman who developed cerebral venous sinus thrombosis after an attempted epidural. The epidural was complicated by an accidental dural puncture and the ensuing headache was initially treated with an epidural blood patch. Cerebral venous sinus thrombosis is an uncommon condition with varying aetiology and risk factors. We discuss the importance of the differential diagnosi...

OBJECTIVE Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. STUDY DESIGN Normal term nulliparous women in early spontaneous labor were randomized to receive either narcotic or epidural analgesia. RESULTS When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a significant prolonga...

BACKGROUND Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. METHODS Twelve American...

BACKGROUND AND OBJECTIVE Premature epidural catheter termination in the postoperative period is a common cause of epidural analgesia failure. The incidence varies from 5.7 to 13%. A higher incidence of unplanned epidural catheter termination was observed in our hospital. We took this as a quality improvement project, monitored the causes and applied remedial measures at the same time to reduce ...

BACKGROUND Ropivacaine is used by the epidural route for postoperative pain management with various neuraxial techniques. Given the widespread use of these techniques and the relative paucity of data on spinal disposition of local anesthetics, we evaluated through an experimental animal model, the spinal disposition of ropivacaine, allowing further studies of factors influencing their intrathec...

BACKGROUND Individual patient information from clinical trials is infrequently available, but can provide insights for clinical trials and practice. METHODS We analysed individual patient information from five randomized trials (913 patients) of i.v. patient-controlled analgesia (IVPCA) plus epidural placebo, morphine sulphate (MS) 5 mg, or extended-release epidural morphine (EREM; DepoDur) a...