BACKGROUND Factors contributing to subarachnoid catheter passage after epidural placement are not well understood. This study explored mechanisms that might explain its occurrence. METHODS Human cadaveric dura was mounted on a model and pressurized to physiologic levels. In a standardized fashion, a 20-gauge Portex three-port, closed end (nonflexible) tip catheter was passed through an epidur...

We read the article by Zhu et al (1) regarding an alternative approach for lumbar transforaminal epidural steroid injections. We found that their work was similar to our previously reported article, “Fluoroscopically guided transforaminal epidural dry needling for lumbar spinal stenosis using a specially designed needle” (2). In our article, we introduced a minimally invasive interventional tec...

INTRODUCTION The risk of postdural puncture headache following lumbar puncture can be reduced by choosing a blunt spinal needle or by using a smaller needle diameter. Reports indicate that lumbar puncture practiced outside of the anaesthetic discipline does not adhere to the current level of evidence. To examine the practice among haematologists in Denmark, we performed a national survey. In ad...

We describe a case with a 50-yr-old, healthy woman who developed neurological symptoms associated with left foot drop following Combined Spinal Epidural Anesthesia (CSEA) for right total knee arthroplasty. She complained of paresthesia and pain during insertion of the 27-G, atraumatic spinal needle which was believed to be introduced at the L2-3 interspace after the 18-G epidural needle. Howeve...

BACKGROUND Many surgeries are performed under spinal anesthesia. Inexperienced practitioners may find it difficult to obtain subarachnoid access. OBJECTIVES This study aimed to examine the relationship between patients' anthropometric characteristics and depth of spinal needle insertion to the subarachnoid cavity. PATIENTS AND METHODS 385 patients with ASA class I - II, aged 18 - 65 years a...

Introduction It is sometimes difficult for some patients to optimally flex their hips and knees making traditional position for induction of spinal anaesthesia difficult to achieve. The ease of induction of spinal anaesthesia was compared with patients in sitting position with legs remaining on the table (new sitting method) versus legs placed on the side stool (traditional sitting method). M...

Postdural puncture back pain has a reported incidence ranging from 2% to 29% following the administration of a spinal anesthetic. The purpose of this investigation was to compare the back pain and patient satisfaction scores after the administration of a spinal anesthetic with or without the use of an 18-gauge introducer needle. Eighty-four men and women were randomly assigned to either control...

Thoracic Epidurals: Anatomic Explanation Central neuraxial block has a low incidence of major complications, many of which resolve within 6 months. During attempts to insert a spinal needle into the lumbar subarachnoid space, patients occasionally experience paresthesia, with a reported incidence of 13.6%. Neurologic complications, including spinal cord injury, may arise during administration o...