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Canadian Journal of Anesthesia, Vol 45, 170-174, Copyright © 1998 by Canadian Anesthesiologists' Society

ARTICLES

A surgically placed epidural catheter in a patient with spinal trauma

DD Seal, RG Loken and RJ Hurlbert
Department of Anaesthesia 1, Foothills Hospital, University of Calgary, Alberta.

PURPOSE: To report the successful perioperative anaesthetic and analgesic management of a spinal trauma patient with a surgically placed epidural catheter. CLINICAL FEATURES: A 15-yr-old adolescent woman sustained an unstable spinal column injury with an incomplete neurological deficit following a high speed motor vehicle accident. She was scheduled for spinal decompression and stabilisation through a left thoracoabdominal approach. Balanced general anaesthesia was undertaken. Prior to closure, a multi-orifice epidural catheter was surgically placed under direct vision 5 cm into the anterior epidural space. The catheter was then tunnelled out through the psoas muscle and secured in place. Combined epidural-general anaesthesia was then initiated for the duration of the case using 5 ml bupivacaine 0.25% after an initial test dose of 3 ml lidocaine 1.5% with epinephrine. An infusion of bupivacaine 0.10% and fentanyl 5 micrograms.ml-1 at 8 ml.hr-1 using patient controlled epidural analgesia (PCEA) provided excellent postoperative pain control for four days. She had an uncomplicated postoperative course. CONCLUSION: A surgically placed epidural catheter provided excellent, safe, perioperative anaesthesia and analgesia in this patient with unstable spinal trauma.


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P. J. A. Sice, D. Chan, and P. A. MacIntyre
Epidural analgesia after spinal surgery via intervertebral foramen
Br. J. Anaesth., March 1, 2005; 94(3): 378 - 380.
[Abstract] [Full Text] [PDF]


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Copyright © 1998 by the Canadian Anesthesiologists' Society.