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Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test)

[Le colmatage sanguin épidural thoracique ciblé, guidé par la stimulation électrique (test Tsui)]

Patricia K. Morley-Forster, MD FRCPC^*, Ahmed Abotaiban, MD^*, Sugantha Ganapathy, MD FRCPC^*, Dwight E. Moulin, MD FRCPC, Andrew Leung, MD FRCPC and Ban Tsui, MD FRCPC

^* From the Department of Anesthesia and Perioperative Medicine, University of Western Ontario Interdisciplinary Pain Program, London, Ontario; and the
Departments of Clinical Neurological Sciences,
Medical and Diagnostic Imaging; and
Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada.

Address correspondence to: Dr. Patricia K. Morley-Forster, Earl Russell Chair in Pain Management, St Joseph’s Health Care, 268 Grosvenor St., London, Ontario N6A 4V2, Canada. Phone: 519-646-6000 ext. 65065; Fax: 519-646-6376; E-mail: pat.morley-forster{at}sjhc.london.on.ca

Purpose: This case report describes the use of electrical epidural stimulation (Tsui test) to confirm accurate placement of a thoracic epidural catheter when administering an epidural blood patch for headache management in a patient suffering from spontaneous intracranial hypotension.

Clinical features: A 41-yr-old female presented to the Chronic Pain Clinic with a history of postural headache symptoms worsening in severity over several years. Two previous blood patches performed at T11–12 and T10–11 respectively provided short-term relief only. The presumed diagnosis of a spontaneous dural tear was confirmed by a nuclear flow test to be at T2–T4. The epidural site was accessed at T6 with a Tuohy needle. To accurately place the epidural blood patch at the level of the dural tear, the Arrow catheter with electrode adapter was advanced under nerve stimulation guidance to T4. Ten millilitres of autologous blood injected through the catheter was confirmed on magnetic resonance imaging, one hour postprocedure, to lie between T3 and T9. Sustained headache relief was achieved.

Conclusion: The use of electrical stimulation guidance may be useful when precise epidural blood patch placement is required.

This article has been cited by other articles:

				M. Beriault and P. Korzeniewski Risks of dural puncture associated with thoracic epidurals. Can J Anesth, September 1, 2006; 53(9): 964 - 965. [Full Text] [PDF]

				P. Morley-Forster, B. Tsui, S. Ganapathy, and A. Abotaiban REPLY Can J Anesth, September 1, 2006; 53(9): 965 - 966. [Full Text] [PDF]