الفهرس 
Vertebral BonesOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: Postoperative epidural analgesia provides superior postoperative analgesia at rest and with activity,
compared with systemic opioids. However, the impact of postoperative epidural analgesia on postoperative morbid-
ity and/or mortality remains controversial, because of the sub-optimal reliability of epidural catheters that are placed
preoperatively and used for postoperative pain control. The present study used the technique of lumbar epidurogra-
phy. The study aims to better understand the possible correlation between the fuoroscopic characteristics of epidural
catheters following injection of contrast medium and the postoperative functional characteristics regarding analgesia.
In this single-arm clinical trial, 70 patients, aged 50 to 75 years old, underwent surgical urological procedures, involv-
ing incisions up to T
8 dermatome, under combined general and epidural anesthesia. At the L2-L3 level, the epidural
space was reached using the loss of resistance technique before general anesthesia was induced. The catheters were
threaded upwards for 4–6 cm. Preoperative epidurograms were then done by injecting a 3-ml contrast medium
OmnipaqueTM (240 mg I/ml) in the epidural catheters. The epidurograms were investigated for the location of the
catheter tip in relation to the vertebral body, the extent of dye spread, laterality of dye spread (midline, right, or left),
and the presence or absence of dye spread anterior to the spinal cord on the lateral image. The patients were fol-
lowed postoperatively while epidural analgesia was infused.
Results: Both the postoperative epidural infusion and postoperative visual analog scale (VAS) scores were lower
when catheter tips ended at L1 than when they ended at L2. As the contrast’s vertical spread increases in preoperative
epidurograms, the analgesic infusion rate and VAS score decrease, and the number of dermatomes insensitive to cold
increases. Epidurographically right-sided catheters showed more dermatomes defcient to cold sensations on the
right side, compared with mid-line and left-sided catheters. Restriction of contrast to the posterior epidural space was
associated with lower VAS scores and wider anesthesia to cold.
Conclusions: The use of epidurography to study epidural catheters may have the potential advantage of predicting
the functionality of catheters and improving the reliability of postoperative epidural analgesia.