The influence of neck flexion and extension on the distribution of contrast medium in the high thoracic epidural space
BACKGROUND: For safe and effective thoracic epidural analgesia (TEA), it is important to control the level of TEA and to identify factors that influence its spread. In this study, we observed the distribution of contrast injected into the high thoracic epidural space during neck flexion and extension.
METHODS: An epidural catheter was inserted into the epidural space until its tip was located at the T1-2 intervertebral level. Patients were randomly allocated to three groups (extension, flexion, and neutral groups), and were injected with 5 mL of contrast when the neck was extended, flexed, or in the neutral position. Extent of contrast spread was determined by counting the number of vertebral body units (VBUs) through lateral epidurography.
RESULTS: Forty-two patients were equally allocated to the three groups. Radiographic spreads in the cephalad direction (median) was 1.0, 5.5, and 1.5 VBUs in the extension, flexion, and neutral groups, and spread was greater in the flexion than in the other two groups (P < 0.001). Median radiographic caudal spread was 10.0, 10.0, and 7.0 VBUs in the extension, flexion, and neutral groups, respectively, which was not significantly different among groups (P = 0.145).
CONCLUSIONS: Cranial spread of contrast in the high thoracic epidural space is limited. However, neck flexion increases cranial spread. These results suggest that when TEA is high, the tip of the epidural catheter should be located at the upper part of the level to be blocked and that neck flexion may cause an unwanted cervical block.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2007 |
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| Erschienen: |
2007 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:104 |
|---|---|
| Enthalten in: |
Anesthesia and analgesia - 104(2007), 6 vom: 15. Juni, Seite 1583-6, table of contents |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Lee, Chul Joong [VerfasserIn] |
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| Themen: |
Comparative Study |
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| Anmerkungen: |
Date Completed 14.06.2007 Date Revised 24.11.2016 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM170394204 |
|---|
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| 100 | 1 | |a Lee, Chul Joong |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The influence of neck flexion and extension on the distribution of contrast medium in the high thoracic epidural space |
| 264 | 1 | |c 2007 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 14.06.2007 | ||
| 500 | |a Date Revised 24.11.2016 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: For safe and effective thoracic epidural analgesia (TEA), it is important to control the level of TEA and to identify factors that influence its spread. In this study, we observed the distribution of contrast injected into the high thoracic epidural space during neck flexion and extension | ||
| 520 | |a METHODS: An epidural catheter was inserted into the epidural space until its tip was located at the T1-2 intervertebral level. Patients were randomly allocated to three groups (extension, flexion, and neutral groups), and were injected with 5 mL of contrast when the neck was extended, flexed, or in the neutral position. Extent of contrast spread was determined by counting the number of vertebral body units (VBUs) through lateral epidurography | ||
| 520 | |a RESULTS: Forty-two patients were equally allocated to the three groups. Radiographic spreads in the cephalad direction (median) was 1.0, 5.5, and 1.5 VBUs in the extension, flexion, and neutral groups, and spread was greater in the flexion than in the other two groups (P < 0.001). Median radiographic caudal spread was 10.0, 10.0, and 7.0 VBUs in the extension, flexion, and neutral groups, respectively, which was not significantly different among groups (P = 0.145) | ||
| 520 | |a CONCLUSIONS: Cranial spread of contrast in the high thoracic epidural space is limited. However, neck flexion increases cranial spread. These results suggest that when TEA is high, the tip of the epidural catheter should be located at the upper part of the level to be blocked and that neck flexion may cause an unwanted cervical block | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 7 | |a Contrast Media |2 NLM | |
| 700 | 1 | |a Jeon, Yunseok |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Young Jin |e verfasserin |4 aut | |
| 700 | 1 | |a Bahk, Jae Hyon |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Yong Chul |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Sang Chul |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Chong Sung |e verfasserin |4 aut | |
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