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Canadian Journal of Anesthesia, Vol 11, 72-82, Copyright © 1964 by Canadian Anesthesiologists' Society

Continuous Epidural Analgesia–The Use of an Intermittent Injection Device

J M R COX MB, BS1 and W E SPOEREL MD, FRCP(C)1

1 Department of Anaesthesia, University of Western Ontario, and Victoria Hospital, London, Ontario

We believe that the results obtained with continuous epidural analgesia maintained with an electrically timed mechanical injection device are encouraging It is our plan to continue this type of treatment and to investigate the use of more flexible injection devices with a greater sterility factor than the one reported in this presentation It is felt that the use of such a device contributes towards a more exact treatment and at the same time frees personnel from the constant pressure of observing a time schedule The hazard introduced by a device such as this does not, in our opinion, exceed that of repeated manual injections given by a variety of persons Like any other form of treatment, adequate supervision by nurses and physicians familiar with this technique is essential With intermittent injections of constant volume and exact timing it has become evident that the main obstacle towards the maintenance of a continuous epidural analgesia is tachyphylaxis By this we mean a diminished duration of action of the local anaesthetic as well as a diminution of potency At present there is no satisfactory explanation for this phenomenon

In all patients it was necessary in the course of treatment to increase the strength of the anaesthetic solution and frequently to add adrenaline to the solutions to obtain a duration of analgesia for one hour using either Xylocame or Carbocame On occasion the duration of action became so short that a continuation of the treatment was not possible Local irritation caused by the catheter or the local anaesthetic agent was observed in three patients Symptoms disappeared upon withdrawal of the catheter and there were no after-effects

Hypotension did not present as great a problem as anticipated One patient with known coronary artery disease died after twelve holurs of continuous epidural analgesia, presumably with coronary infarction

We have used this device for the injection of intermittent intravenous doses of d-tubocurarine in the treatment of tetanus and status epilepticus and believe that its use could be further extended to other agents, such as antibiotics and anticoagulants.

Note:

Presented at the Annual Meeting of the Canadian Anaesthetists' Society, May, 1963, at Montebello, Quebec






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Copyright © 1964 by the Canadian Anesthesiologists' Society.