• The Korean Journal of Pain
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• 제9권2호
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• pp.434-438
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• 1996

Epidural abscess is associated with placement of epidural catheter is very rare. We experienced two cases of epidural abscess formation after placement of epidural catheter for pain management. A 63 years old female patient received thoracic epidural catheterization for management of pain due to herpes zoster on right T4 dermatome. Two weeks after catheterization, she complained of paraparesis and anesthesia below $T_4$ dermatome. Four weeks later magnetic resonance images was performed and revealed epidural abscess on $T_2-T_5$. Emergent decompressive laminectomy was performed but neurologic symptoms were not improved. In other case, a 75 years old male patient received lumbar epidural catheterization for management of Buerger's disease. About on month later, pus was aspirated from lumbar epidural space. But further evaluation could not be achieved because he wanted to discharge against advice. We emphasize that epidural abscess results sequele serious and prompt diagnosis and treatment is important.

• 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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• 제2권1호
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• pp.94-96
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• 1989

경막외 농양의 항생이 경막외 카테타 거치로 인한 것은 드물고 다른 감염증과 골수염의 혈행성 전파로 기인된 것이 대부분이며 원인군은 황색 포도상구균이 가장 많다. 농양 발생시 환자는 농양형성 부위의 통증과 압통, 고열, 하지마비 등의 증상을 나타내게되며 척수조영술이나 전산화 단층촬영 등으로 진단이 가능하며 항생제의 투여와 추궁절제술을 시행하여 농양으로 인한 척수압박을 해소하는 동시에 배농시키는 등의 적극적 치료를 시행하여야 한다. 본 환자는 고령으로 인한 면역능력의 저하와 어울려 카테타 관리 및 약물 주입시의 감염으로 인하여 경막의 농양이 발생하였으나 전신적인 항생제 투여만으로 잘 치유된 경우이다. 이와 같은 합병증을 예방하기 위해서는 경막외 천자시 뿐만 아니라 카테타 거치 후의 카테타 관리 및 카테타를 통한 약물 주입시에도 무균 조작을 철저히 해야할 것이다.

• The Korean Journal of Pain
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• 제11권1호
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• pp.155-159
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• 1998

Epidural neurolysis with phenol has appeared in literature since 1960. Complications due to accidental subdural block is a rare and unexpected sensory and/or motor disturbance, but it does occur. A 74 years old woman had postherpectic neuralgia for 3 weeks and VAS score of 10. She was treated with intercostal nerve block and intravenous infusion of lidocaine for 7 days and VAS score decreased to 6. To proceed further, we decided to perform epidural neurolysis with 4% phenol 1.5 ml. During thoracic epidural catherization, we encountered unexpected subdural catheterization in subdurographic finding, but we could not precisely rule out subdural catheterization. We had to check CT for exact location of catheter tip. We then performed subdural neurolysis with phenol. This procedure reduced VAS score to between 3 and 4, and we removed the catheter. She had no complication.

• The Korean Journal of Pain
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• 제9권2호
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• pp.344-348
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• 1996

Continuous epidural block can be useful in the management of acute and chronic pain. For the most effective analgesia, it is important to localize the tip of epidural catheter and the spread of radiopaque dye. Epidural catheterization was performed in 12 patients on the sitting position. Catheters were advanced by 10 cm cephalad in the cervical epidural space by median approach and radiopaque dye 3 ml was injected through the catheters. The position of cervical epidural catheters and the spread of dye was confirmed by radiography. The course of epidural catheter were: coiled 3/12 (25%), loop 2/12 (16.7%), straight 2/12 (16.7%). In 8 cases, the tip of epidural catheters were located within one vertebral segment from the level of insertion site. Radiopaque dye spreaded average 3.68 vertebral segment to cranially and 1.67 vertebral segment to caudally from the insertion site.

• 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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• 제10권1호
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• pp.127-130
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• 1997

A 67-year old man with a history of cardiac disease underwent epidural catheterization for pain control of postherpetic neuralgia. Patient had severe back pain and pus discharge at catheter insertion site after dischange from medical part. Patient received anticoagulant therapy with $Aspirin^{(R)}$ and $Coumadin^{(R)}$ prescribed for 15 days in medical part. Magnetic resonance imaging(MRI) showed a diffuse $T_{4-7}$ anterior epidural mass compressing the spinal cord. Emergency surgical exploration revealed a thoracic epidural hematoma without abcess formation. Operation was successful and patient recovered satisfactory without any sequelae.

• The Korean Journal of Pain
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• 제20권1호
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• pp.50-53
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• 2007

Background: Continuous epidural catheterization is a popular and effective procedure for postoperative analgesia. However, continuous epidural catheterization has associated complications such as venous puncture, dural puncture, subarachnoid cannulation, suboptimal catheter placement, and paresthesia because the tip of the epidural catheter touches thenerves of the dura in the epidural space. In this study, we compared the incidence of paresthesia in two different lengths of epidural catheter insertion. Methods: One hundred women undergoing gynecologic or orthopedic surgery were enrolled in this prospective, double-blinded, randomized study. All patients were randomly divided into two groups based on the insertion length of the epidural catheter 2 cm (group A) or 4 cm (group B). A Tuohy needle was inserted in the lumbarspinal region with a bevel directed cephalad by use of the median approach, and then the epidural space was confirmed by the loss of resistance technique with air. While the practitioner inserted an epidural catheter into the epidural space, a blind observer checked for paresthesia or withdrawal movement. Results: In 97 included patients, 30.6% of the patients in group A (n = 49) had paresthesia, versus 31.3% in group B (n = 48). Withdrawal movements were represented in 2% and 6% of the patients in group A and group B, respectively. There was no difference in the incidence of paresthesia and withdrawal movement between the two groups. Conclusions: There is no clear relationship for the incidence of catheter-related paresthesia according to the catheter length inserted into the epidural space for epidural analgesia.

• Korean Journal of Anesthesiology
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• 제71권6호
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• pp.430-439
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• 2018

In infants and small children, ultrasound (US) guidance provides ample anatomical information to perform neuraxial blocks. We can measure the distance from the skin to the epidural space in the US image and can refer to it during needle insertion. We may also visualize the needle or a catheter during real-time US-guided epidural catheterization. In cases where direct needle or catheter visualization is difficult, US allows predicting successful puncture and catheterization using surrogate markers, such as dura mater displacement, epidural space widening due to drug injection, or mass movement of the drug within the caudal space. Although many experienced anesthesiologists still prefer to use conventional techniques, prospective randomized controlled trials using US guidance are providing increasing evidence of its advantages. The use of US-guided regional block will gradually become widespread in infants and children.

• The Korean Journal of Pain
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• 제9권1호
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• pp.271-274
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• 1996

Epidural hematoma during anticoagulant therapy is a rare complication of central neural blockade, but it may result in serious neurologic sequelae. A 61-year-old male receiving warfarin due to heart failure was referred to the pain clinic for control of severe herpetic neuralgia. Epidural catheterization was done at $T_{8-9}$ interspace. At that time, PT and aPTT were extremely prolonged. The next morning, severe back pain, motor paralysis and urinary difficulty developed. On spine MRI, epidural hematoma was detected at $T_{8-9}$ interspace. Four days later, he died due to underlying diseases. Central neural blockade in patient with anticoagulant therapy is contraindicated in most cases. If is undertaken, close observation of patients's neurologic functions and monitoring of coagulation profiles(PT, aPTT, etc) are necessary. If epidural hematoma develops, early surgical decompression is mandatory.