• The Korean Journal of Pain
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• 제11권2호
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• pp.230-234
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• 1998

Background: Continuous epidural block is widely used for surgical operation and postoperative pain management. The potential infection due to the epidural catheter is a definite harzard of continous epidural block. We investigated the effectiveness of bacterial filter in prevention of infection due to the epidural catheter. Methods: Patients scheduled for transabdominal hysterectomy were assigned to two groups by simple randomization (50 patients per group). All catheters were placed in the 2nd and 3rd lumbar epidural space, using careful sterile technique. Group 1 received injections by the epidural catheter with a bacterial filter and group 2 received injections by the epidural catheter without a bacterial filter. The infection rate in the tips of epidural catheter left for 3 days were compared between the two groups. Results: There was no significant difference in the infection rate between two groups. Conclusions: A bacterial filter of the epidural catheter for surgical anesthesia and postoperative analgesia dose not prevent all kinds of infection in continuous epidural block.

• The Korean Journal of Pain
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• 제4권1호
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• pp.26-30
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• 1991

Continuous epidural analgesia is widely used in pain management. We investigates the incidence of contamination of epidural catheters used in epidural catheters for pain control. The tips of epidural catheters were examined for bacterial growth after use. In culture from 250 patients undergoing continuous epidural catheterization, 33(13.2%) catheters were found to be contaminated: staphylococcus epidermis 66.9%; staphylococcus aureus 12.1%; alpha streptococcus 12.1%; and others 9.1%. One significant epidural infection occured. One of the most common causes of the epidural infection during long time epidural block is the transmission of the microorganism from the contaminated skin to the epidural space along the epidural catheter. To prevent epidural infection, sterilization of the skin around the epidural catheter is essential.

• The Korean Journal of Pain
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• 제19권2호
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• pp.164-167
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• 2006

Background: There have been an increasing number of reports about infection-related complications after epidural block, and the analysis of these previous reports may offer valuable information for the prevention and treatment of such complications. Methods: We searched for complications about infection that was related to epidural blockade procedures by using the Medline Search program. We analyzed the types of infection-related complications as well as the potential risk factors, the time course from symptom development to treatment, the causative organisms and the treatment outcomes. Results: Seventeen cases were identified. The types of complications were epidural abscess, subdural abscess, spinal arachnoiditis, bacterial meningitis and aseptic meningitis. Five patients received a single block and twelve patients received a continuous block with catheterization. The most common site of epidural catheterization was the lumbar area and eight patients had indwelling catheters for less than fifteen days. Eight patients had a diabetes mellitus as a risk factor and fourteen patients showed less than seven days from the development of symptoms to treatment. Eleven patients received laminectomy and intravenous antibiotics as a treatment and eight patients had full recovery without neurological deficit. Conclusions: Early diagnosis and treatment is essential for the favorable outcome of infection-related complication after epidural block. In addition, absolute sterile technique should always be performed and patient education concerning these potential complications must be accompanied.

• The Korean Journal of Pain
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• 제2권1호
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• pp.97-99
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• 1989

Epidural block is used extensively in each of the fields of surgical anesthesia, obstetric anesthesia, and diagnosis and management of acute and chronic pain. New developments in the understanding of pain conduction have extended the use of continuous epidural blockade to the administration of drugs that selectively block pain conduction while leaving sensation and motor power essentially unchanged. The safety and the reliability of spinal epidural catheter techniques have permitted relief of acute and chronic pain. However, one of the important aspects of the management of the epidural catheter is the possibility of epidural infection. We have experienced a case of epidural infection during control of post-herpetic neuralgia and discuss management of the epidural catheter in this article.

• The Korean Journal of Pain
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• 제8권2호
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• pp.308-311
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• 1995

The incidence of contamination of epidural catheters used for pain control was investigated. To prevent epidural infection, all patients with epidural catheters had taken amoxacillin 1.5gm/day orally. Of the cultures of catheters catched from 303 patients undergoing continuous epidrual catheterization, 5 catheters (1.7%) were found to be contaminated; cervical 1/86 (1.2%), thoracic 1/27 (3.7%), and lumbar 3/190 (1.6%). Staphylococcus epidermidis was the most common etiologic agent (60%). To prevent epidural infection, sterilization of the skin around the epidural catheter and prophylactic use of broad-spectrum antibiotics are thought to be beneficial.

• The Korean Journal of Pain
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• 제9권2호
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• pp.430-433
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• 1996

It is common practice to use epidural catheter for anesthesia or for postoperative analgesia and other kinds of pain control. However, Intraspinal infection associated with this practice is rare event. We report a case of spinal subdural abscess occuring in patient who had recently received epidural catheterization. The cause in this case is not certain, although infection from the epidural catheter is the best possibility. We recommand an aseptic technique in all procedure for epidural or spinal analgesia.

• The Korean Journal of Pain
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• 제9권1호
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• pp.275-278
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• 1996

The placement of epidural catheter may cause complications such as epidural hematoma, epidural abscess and neural damage. Among the above complications, epidural abscess is a rare but serious complication. This report pertains to a diabetic metlitus patient who developed spinal epidural and subdural abscess after continuous epidural catheterization for management of pain caused by reflex sympathetic dystrophy. The patient experienced urinary incontinence, as a neurologic sign, 8 days after epidural catherization. In was considered that the poor prognosis was due to a combination effects of a delayed visit to the hospital for treatment, rapid progression of abscess and uncontrolled blood sugar level. We therefore recommend aseptic technique and proper control of blood sugar level to prevent infection during and after epidural catheterization for diabetic patients. Early diagnosis of epidural abscess following surgical procedure must be required to avoid sequelae.

• The Korean Journal of Pain
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• 제3권1호
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• pp.59-62
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• 1990

Epidural block is used for surgical analgesia, postoperative pain management, obstetric relief and management of chronic pain. Long-term pain control for chronic pain is achieved by development of epidural catheter placement technic. But long term placement of epidural catheteter has several problems, epidural hematoma, epidural absess and neural damage. We had successfully managed long-term placement of epidural catheter in patient with diabetic neuropathy who was susceptable to infection. The duration of epidural catheter placement was 416 days and specific complication was not occurred.

• Journal of Yeungnam Medical Science
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• 제30권1호
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• pp.36-38
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• 2013

While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.

• The Korean Journal of Pain
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• 제12권1호
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• pp.95-100
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• 1999

Background: About 75% of terminal cancer patients have severe pain. For the treatment of these patients, physicians usually use potent opioid analgesics. But many of the cancer patients were not controlled by IV or IM injection of opioids. In spite of the untreatable nature of the patient's illness, they should be hospitalized only for pain control. In that case, epidural opioid injection is one of the most effective methods in pain management. Methods: We retrospectively analyzed 126 terminal cancer patients who were treated with epidural morphine for pain management from 1993-97. In the routine procedure, an epidural catheter was inserted into the epidural space and tunnelled subcutaneously, exiting out from the anterior chest or abdomen. Morphine was used as the main analgesic and Multiday Infusor$^{(R)}$ (Baxter, 0.5 ml/h) as a continuous infusion system. Results: 1. Mean treatment time was 55 days (range; 3~373). 2. Mean daily epidural start mg dose of morphine was 8 mg (range; 2~20). 3. Mean daily dose at termination was 19 mg (range; 4~60) 4. 94 patients were controlled with continuous infusion but 32 patients needed additional bolus doses of morphine. 5. heter-associated subcutaneous infection occurred in 2 patients (1.6%). Conclusion: Terminal cancer pain management administered by a tunnelled epidural catheter is a simple, inexpensive method with a very small rate of infection.