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Original Article

Korean J Pain 2010; 23(4): 247-253

Published online December 31, 2010 https://doi.org/10.3344/kjp.2010.23.4.247

Copyright © The Korean Pain Society.

Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position

Tetsuya Uchino, MD*, Satoshi Hagiwara, MD, Hideo Iwasaka, MD, Kyosuke Kudo, MD, Junji Takatani, MD, Akio Mizutani, MD, Masahiro Miura, MD*, and Takayuki Noguchi, MD

Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, Yufu, Japan.

*Department of Human Anatomy, Oita University Faculty of Medicine, Yufu, Japan.

Correspondence to: Tetsuya Uchino, MD. Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, 1-1, Idaigaoka-Hasamamachi, Yufu 879-5593, Japan. Tel: +81-97-586-5943, Fax: +81-97-586-5949, utetsuya@oita-u.ac.jp

Received: August 23, 2010; Revised: October 26, 2010; Accepted: October 30, 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain.

Methods

In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging.

Results

The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery.

Conclusions

Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

Keywords: epidural anesthesia, iotrolan, pain, postoperative, radiography