The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지

Vertebral Spreading Segments of Cervical Epidural Injection: a Comparative Study with 5 ml and 10 ml of Injected Volume

경부경막외차단 시 약물의 용량에 따른 약물 분포 범위: 5 ml와 10 ml 주입량에 대한 비교 연구

  • Lee, Sang Eun (Pain Clinic, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine) ;
  • Han, Kyung Ream (Pain Clinic, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine) ;
  • Kim, Chan (Pain Clinic, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine) ;
  • Chae, Yun Jeong (Pain Clinic, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine) ;
  • Yoo, Ji Young (Pain Clinic, Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine)
  • 이상은 (아주대학교 의과대학 아주대학교병원 마취통증의학과) ;
  • 한경림 (아주대학교 의과대학 아주대학교병원 마취통증의학과) ;
  • 김찬 (아주대학교 의과대학 아주대학교병원 마취통증의학과) ;
  • 채윤정 (아주대학교 의과대학 아주대학교병원 마취통증의학과) ;
  • 유지영 (아주대학교 의과대학 아주대학교병원 마취통증의학과)
  • Received : 2006.10.09
  • Accepted : 2006.12.01
  • Published : 2006.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Although cervical epidural block can be a useful therapeutic treatment for head, neck and upper extremities pain, there is no consensus regarding the volume of injection required for pain management. Herein, the spreading in the vertebral segments after a cervical epidural injection of either a 5 or 10 ml volume was studied. Methods: A total of 78 patients, suffering from head, neck and upper extremity pain, were selected. Cervical epidural blocks were performed consecutively with 5 ml (n = 42) and 10 ml (n = 36) of 0.4% mepivacaine and 222 mg I/ml iopamidol at the C7⁣-T1 levels. Both anteroposterior (AP) and lateral radiographs were obtained under fluoroscopy, and the upper and lower epidural spreading of the contrast media in relation to the vertebral level was evaluated. Results: The cervical epidural blocks were performed without complications. The rostral spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.6{\pm}1.1$ and $6.1{\pm}1.1$, respectively. The caudal spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.4{\pm}3.4$ and $7.2{\pm}3.9$, respectively. The total numbers of segments with vertebral spreading of the contrast media in both directions showed significant differences between the two groups. The numbers of patients who showed spreading of the contrast media up to C2 vertebral segment showed no significant differences between the two groups. Conclusions: 5 and 10 ml epidural injection volumes may be adequate for the spread of contrast media to the entire cervical spine. A 5 ml epidural injection volume, compared to a 10 ml volume, may be ample when considering the possibility of unnecessary caudal spreading of drugs and volume related complications in the management of head, neck and upper extremity pain.

Keywords

References

  1. Catchlove R, Braha R: The use of cervical epidural nerve blocks in the management of chronic head and neck pain. Can Anaesth Soc J 1984; 31: 188-91 https://doi.org/10.1007/BF03015258
  2. Lin EL, Lieu V, Halevi L, Shamie AN, Wang JC: Cervical epidural steroid injections for symptomatic disc heruiations. J Spinal Disord Tech 2006; 19: 183-6 https://doi.org/10.1097/01.bsd.0000190558.13248.e1
  3. Waldman SD: Interventional pain management. 2nd ed. Philadelphia, Saunders. 2001, pp 373-81
  4. Botwin KP, Natalicchio J, Hanna A: Fluroscopic guided lumbar interlaminar epidural injection: a prospective evaluation of epidurography contrast patterus and anatomical review of the epidural space. Pain Physician 2004; 7: 77-80
  5. Botwin K, NatalicchioJ, Brown LA: Epidurography contrast patterus with fluoroscopic guided lumbar transforaminal epidural injections: a prospective evaluation. Pain Physician 2004; 7: 211-5
  6. Stojanovic MP, Vu TN, Caneris 0, Slezak J, Cohen SP, Sang CN: The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine 2002; 27: 509-14 https://doi.org/10.1097/00007632-200203010-00011
  7. Gael A, PollanJJ: Contrast flow characteristics in the cervical epidural space: an analysis of cervical epidurograms. Spine 2006; 21: 1576-9
  8. Cheng PA: The anatomical and clinical aspects of epidural anesthesia. I. Anesth Analg 1963; 42: 398-406
  9. Grundy EM, Rao LN, Winnie AP: Epidural anesthesia and the lateral position. Anesth Analg 1978; 57: 95-7
  10. Foldes FF, Colavincenzo JW, Birch JH: Epidural anesthesia: a reappraisal. Curr Res Anesrh Analg 1956; 35: 89-100
  11. Lee SC: Spreading pattern of epidurally-admininistered contrast media in rabbits. Korean J pain 1997; 10: 231-4
  12. Waldman SD: Complications of cervical epidural nerve blocks with steroids: a prospective study of 790 consecutive blocks. Reg Anesth 1989; 14: 149-51
  13. Du Pen SL, Williams AR, Feldman RK: Epidurograms in the management of patients with long-term epidural catheters. Reg Anesth 1996; 21: 61-7
  14. Slappendel R, Gielen MJ, Hasenbos MA, Heystraten FM: Spread of radiopaque dye in the thoracic epidural space. Anaesthesia 1988; 43:939-42 https://doi.org/10.1111/j.1365-2044.1988.tb05656.x
  15. Yokoyama M, Hanazaki M, Fujii H, Mizobuchi S, Nakarsuka H, Takahashi T, et al: Correlation between the disrribution of conrrast medium and the extent of blockade during epidural anesthesia. Anesthesiology 2004; 100: 1504-10 https://doi.org/10.1097/00000542-200406000-00024
  16. Park WY, Hagins FM, Massengale MD, Macnamara TE: The sitting position and anesthetic spread in the epidural space. Anesth Analg 1984; 63: 863-4
  17. Bromage PR: Spread of analgesic solutions in the epidural space and their site of action: a statistical study. Br J Anaesth 1962; 34: 161-78 https://doi.org/10.1093/bja/34.3.161
  18. Burn JM, Guyer PB, Langdon L: The spread of solutions injected into the epidural space: a study using epidurograms in patients with the lumbosciatic syndrome. Br J Anesth 1973; 45: 338-45 https://doi.org/10.1093/bja/45.4.338
  19. Sairoh K, Hirabayashi Y, Shimizu R, Mitsuhata H, Fukuda H: Extensive extradural spread in the elderly may not relate to decreased leakage through intervertebral foramina. Br J Anaesth 1995; 75: 688-91 https://doi.org/10.1093/bja/75.6.688
  20. Grundy EM, Ramamurthy S, Patel KP, Mani M, Winnie AP: Extradural analgesia revisited. A statistical study. Br J Anaesth 1978;50: 805-9 https://doi.org/10.1093/bja/50.8.805
  21. Sjogren P, Gefke K, Banning AM, Parslov M, Overgaard Olsen LB: Lumbar epidurography and epidural analgesia in cancer patients. Pain 1989; 36: 305-9 https://doi.org/10.1016/0304-3959(89)90089-4
  22. Valk J, Crezee FC, de Slegte RG, Hazenberg GJ, Wolbers J, Bach-Gansmo T: Iohexol 300 mg Ilml versus Iopamidol 300 mg Ifml for cervical myelography double blind trial. Neuroradiology 1987; 29:202-5 https://doi.org/10.1007/BF00327551
  23. Seeling W, Tomczak R, Merk J, Mrakovcic N: CT-epidurography. A comparison of conventional and CT-epidurography with contrast medium injection through a thoracic epidural catheter. Anaesthesist 1995; 44: 24-36 https://doi.org/10.1007/s001010050129