Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incide...

The administration of anti-platelet agents to surgical patients with a history of coronary artery disease or peripheral vascular disease represents an everyday challenge to anaesthesiologists when epidural anaesthesia or analgesia is to be considered. Practice guidelines suggest stopping clopidogrel at least 7 days before placing an epidural catheter. Withholding anti-platelet drugs represents ...

The aim of this work was to study the cerebrospinal fluid (CSF) bioavailability and pharmacokinetics of bupivacaine (BUP) and lidocaine (LID) administered separately in rabbits using microdialysis with retrodialysis calibration. Microdialysis probe and catheters were inserted under control of the view in the intrathecal or epidural spaces. The epidural disposition of BUP and LID after epidural ...

Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome f...

BACKGROUND The authors conducted this prospective study to determine the incidence, potential routes, and risk factors of microbial colonization of epidural catheter used for postoperative pain control. METHODS Two-hundred five patients with epidural analgesia for postoperative pain were studied. On removal of the catheter, five samples were sent for culture: the infusate, a swab from inside ...

BACKGROUND Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. OBJECTIVES To assess the effects of all modalities of epidural analgesia (including combined -spinal...

Epidural analgesia is used by more than half of laboring women, yet there is no consensus about what unintended effects it causes. To evaluate the state of our knowledge, we performed a systematic review of the literature examining the unintended maternal, fetal, and neonatal effects of epidural analgesia used for pain relief in labor by low-risk women. Our review included randomized and observ...

Correspondence Post-thoracotomy epidural vs paravertebral analgesia Editor.-I read with interest the article by Richardson and colleagues on post-thoracotomy pain.' The authors compared thoracic paravertebral bupivacaine (bolus of 0. 5 6 followed by infusion of 0.5%) with thoracic epidural bupivacaine (bolus of 0.25% followed by infusion of 0.25%). Both groups received PCA morphine. The paraver...

Epidural analgesia has widespread use in infants and children for postoperative pain management and for certain chronic pain conditions such as cancer pain and complex regional pain syndrome. While epidurals can provide excellent analgesia in pediatric patients, they do require specific expertise in both the techniques of placement and in the management. Pediatric-specific protocols and guideli...

OBJECTIVES To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement. METHODS 200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a cauda...