The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Comparison of Methods to Confirm the Cervical Epidural Space

경추 경막외강 확인법의 비교 연구

  • Ok, Si Young (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Chun, Hae Rim (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Baek, Young Hee (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Sang Ho (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Soon Im (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Sun Chong (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Park, Wook (Departments of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University) ;
  • Song, Dan (Departments of Surgery, College of Medicine, Soonchunhyang University)
  • 옥시영 (순천향대학교병원 마취통증의학과) ;
  • 전혜림 (순천향대학교병원 마취통증의학과) ;
  • 백영희 (순천향대학교병원 마취통증의학과) ;
  • 김상호 (순천향대학교병원 마취통증의학과) ;
  • 김순임 (순천향대학교병원 마취통증의학과) ;
  • 김선종 (순천향대학교병원 마취통증의학과) ;
  • 박욱 (순천향대학교병원 마취통증의학과) ;
  • 송단 (순천향대학교병원 외과)
  • Received : 2009.06.29
  • Accepted : 2009.07.30
  • Published : 2009.08.01
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Abstract

Background: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. Methods: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. Results: Using the drip infusion method, we identify the epidural space in all the patients as ＋/＋＋ grade. The catheter insertion method was also successful in identifying those epidural spaces over a ${\pm}$ grade. The pseudo LOR was over ${\pm}$ grade in 47 patients. Conclusions: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.

Keywords

References

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