Abstract
We have so far experienced about 5, 000 cases of epidural anesthesia. In the present study, we further examined whether or not a difference may occur in the run of the catheter when the local anesthetic is first infused and then the catheter is inserted into the epidural space, or vice versa, in 87 cases of lumbar, thoracic or cervical epidural anesthesia. The catheter for continuous epidural anesthesia used in this study was a polyethylene catheter manufactured by Hakko Co., Ltd., and 1-1.5% mepivacaine was used as the local anesthetic. 0.5ml of meglumine iocarmic acid was infused into the epidural catheter in order to confirm the location and course of the catheter. In the cervical and thoracic epidural anesthesia, almost 80% of the cases showed a straight course, irrespective of whether the catheter was inserted prior to or after the infusion of the local anesthetic, showing no significant difference between the two methods.
In the lumbar epidural anesthesia, almost 90% of the cases showed a straight course when the local anesthetic was infused prior to the insertion of the catheter, while only 50% of the cases exhibited a straight course when the catheter was inserted first, resulting in a significant difference between the two methods. Furthermore, we compared the results of two methods of catheter insertion: one, the usual method, inserting about 5cm of the catheter through the needle and withdrawing the needle alone, and the other, inserting about 20cm of the catheter through the needle and withdrawing them together to leave a proper length of the catheter behind (the latter method we reported at the 16th annual Kanto Koshin-etsu District meeting of Japan Society of Anesthesiology). No significant difference was noted between the two methods.
