This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsui, B. C.H. Articles by Finucane, B. Search for Related Content PubMed PubMed Citation Articles by Tsui, B. C.H. Articles by Finucane, B. Related Collections Regional Anesthesia and Pain

Detection of subdural placement of epidural catheter using nerve stimulation

From the Department of Anesthesiology and Pain Medicine, and the Department of Diagnostic Imaging,
^* University of Alberta Hospitals, Walter Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7 Canada.

Address Dr. Ban C.H. Tsui. Phone: 780-407-8861; Fax: 780-407-3200; E-mail: btsui{at}ualberta.ca

Purpose: To report the detection of a subdural catheter placement using nerve stimulation through an epidural catheter.

Clinical features: An 85-yr-old gentleman was scheduled for radical cystectomy and creation of an ileal conduit. Combined general anesthesia and regional technqiue was selected. An epidural catheter (19 G Arrow Flextip Plus) was inserted prior to induction of general anesthesia. Intra-operatively, the patient received 5 mg morphine and 10 ml bupivacane 0.5% via the epidural catheter. The patient remained hemodynamically stable throughout the operation and did not require intravenous opioids. The patient was discharged to the ward with an order for epidural morphine for pain control. The next day, the patient remained comfortable. As an ongoing quality assessment to survey the success rate of epidural catheters at our institution, all patients are invited to have their catheter assessed using an electrical epidural stimulation test. Electrical stimulation (1-10mA) with a segmental motor response (truncal or extremities movement) indicates that the catheter is in the epidural space. No motor response indicates that it is not. In this case, subdural catheter placement was suspected because a diffuse motor response including right anterior chest wall, back muscle, and bilateral lower extremities was observed using only 0.3 mA. Subdural catheter placement was subsequently confirmed by a radiograph showing a very thin film of dye spreading cephalad and caudad over many segments.

Conclusion: This new electrical test helps to detect subdural placement objectively.

This article has been cited by other articles:

				B. C. H. Tsui Epidural stimulation test criteria. Anesth. Analg., September 1, 2006; 103(3): 775 - 776. [Full Text] [PDF]

				B. C. H. Tsui Is It Time to Perform All Thoracic Epidural Placements Under Fluoroscopy? Anesth. Analg., May 1, 2006; 102(5): 1586 - 1586. [Full Text] [PDF]

				B. C. H. Tsui Epidural stimulation test vs epidural ECG test for checking epidural catheter placement Br. J. Anaesth., December 1, 2005; 95(6): 837 - 837. [Full Text] [PDF]

				P. Lena and R. Martin Subdural placement of an epidural catheter detected by nerve stimulation: [Positionnement sous-dural d'un catheter epidural detecte par stimulation nerveuse et confirme par tomographie] Can J Anesth, June 1, 2005; 52(6): 618 - 621. [Abstract] [Full Text] [PDF]

				B. C.H. Tsui, A. M. Wagner, K. Cunningham, S. Perry, S. Desai, and R. Seal Threshold Current of an Insulated Needle in the Intrathecal Space in Pediatric Patients Anesth. Analg., March 1, 2005; 100(3): 662 - 665. [Abstract] [Full Text] [PDF]

				S. A. Lang, C. Prusinkiewicz, and B. C.H. Tsui Failed spinal anesthesia after a psoas compartment block: [L'echec de la rachianesthesie apres le bloc de la loge du psoas] Can J Anesth, January 1, 2005; 52(1): 74 - 78. [Abstract] [Full Text] [PDF]

				B. Singh, C. Papneja, V. Datt, B. C. H. Tsui, and S. Malherbe Reversal of an Unintentional Spinal Anesthetic by Cerebrospinal Lavage * Response Anesth. Analg., January 1, 2005; 100(1): 296 - 297. [Full Text] [PDF]

				B. C. H. Tsui, A. Wagner, D. Cave, and R. Seal Threshold Current for an Insulated Epidural Needle in Pediatric Patients Anesth. Analg., September 1, 2004; 99(3): 694 - 696. [Abstract] [Full Text] [PDF]

				B. C.H. Tsui, A. Wagner, and B. Finucane The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model: [Le courant seuil qui produit une reponse motrice est plus faible dans l'espace intrathecal que dans l'espace peridural et ne le chevauche pas: un modele porcin] Can J Anesth, August 1, 2004; 51(7): 690 - 695. [Abstract] [Full Text] [PDF]

				S. A. Lang, B. Tsui, T. Grau, T. Kasai, K. Yaegashi, H. Hirose, and Y. Tanaka New Avenues of Epidural Research * Response Anesth. Analg., July 1, 2003; 97(1): 292 - 293. [Full Text] [PDF]

				B. C.H. Tsui, B. Finucane, and K. Hayatsu Verifying Accurate Placement of an Epidural Catheter Tip Using Electrical Stimulation * Response Anesth. Analg., June 1, 2002; 94(6): 1670 - 1671. [Full Text] [PDF]

				B. C. H. Tsui, R. Seal, J. Koller, L. Entwistle, R. Haugen, and R. Kearney Thoracic Epidural Analgesia Via the Caudal Approach in Pediatric Patients Undergoing Fundoplication Using Nerve Stimulation Guidance Anesth. Analg., November 1, 2001; 93(5): 1152 - 1155. [Abstract] [Full Text] [PDF]