• The Korean Journal of Pain
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• v.22 no.2
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• pp.163-166
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• 2009

The superiority of air versus saline for identifying the epidural space remains unestablished. Epidural anesthesia using a loss of resistance technique (LORT) with air is associated with increasing complications of dural puncture-induced headaches and neurological and hemodynamic changes. Here, we described a case of pneumocephalus with a large amount of air that was accompanied by severe headache and nuchal and chest pain occurring after epidural block using LORT with air for combined spinal-epidural anesthesia.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

• The Korean Journal of Pain
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• v.23 no.3
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• pp.202-206
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• 2010

Magnetic resonance image (MRI) is the most sensitive imaging test of the spine in routine clinical practice. Unlike conventional x-ray examinations and computed tomography scans, high-quality magnetic resonance images can be assured only if patients are able to remain perfectly still. However, some patients find it uncomfortable to remain still because of pain. In that condition, interlaminar cervical epidural injections can reduce pain and allow the procedure. When using air with the "loss of resistance" technique in epidural injections to identify the epidural space, there is the possibility of injected excessive air epidurally to mimic a herniated disc. We describe a case report of epidural air artifact in a cervical MRI after cervical epidural injections.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.286-290
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• 2013

Air injected into the epidural space may spread along the nerves of the paravertebral space. Depending on the location of the air, neurologic complications such as multiradicular syndrome, lumbar root compression, and even paraplegia may occur. However, cases of motor weakness caused by air bubbles after caudal epidural injection are rare. A 44-year-old female patient received a caudal epidural injection after an air-acceptance test. Four hours later, she complained of motor weakness in the right lower extremity and numbness of the S1 dermatome. Magnetic resonance imaging showed no anomalies other than an air bubble measuring 13 mm in length and 0.337 ml in volume positioned near the right S1 root. Her symptoms completely regressed within 48 hours.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.124-129
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• 2009

Background: The "gold standard" for proper epidural catheter positioning is a clinical response, as assessed by a pinprick test. Yet it may take time or it may be difficult to perform this test after epidural catheter placement in sedated or uncooperative patients or during general anesthesia. We assessed the usefulness of aspirating injected air via an epidural catheter as an indicator of correct epidural catheter placement. Methods: We surveyed 200 patients who underwent surgery under general or epidural anesthesia. A Tuohy needle was inserted into the epidural space with using the hanging drop technique. After placement of the epidural catheter, 3 ml of air was injected via the catheter, and then the volume of aspirated air was measured. Results: The mean volume of aspirated air was $2.3{\pm}0.7ml$ (75% of the injected air volume) and this ranged from 0 to 3 ml. Conclusions: Aspiration of injected air is a simple alternative method for identifying the appropriate placement of epidural catheters in the epidural space.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.270-274
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• 1993

Massive extradural spread, distinguished from subarachnoid injection that sometimes follows the introduction of small amounts of local anesthetics or narcotics during attempted epidural anesthesia or analgesia, has been attributed to subdural injection. A 64-year-old woman was admitted for partial radical hysterectomy under general anesthesia after insertion of lumbar epidural cathter by loss of resistance technique with 5 ml of air. In this case, we experienced severe respiratory depression and loss of consciousness after administration of 4 mg of morphine for postoperative pain control. We confirmed air shadows at right silvian and suprasella cisterna region by CT scanning. Patients was recovered without sequele after 2 days, As this case resembles a "massive epidural", it is suggested that subdural injection rather than epidural injection may explain the phenomenon.

• The Korean Journal of Pain
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• v.30 no.4
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• pp.281-286
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• 2017

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015. All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.317-323
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• 2017

This study was conducted to investigate the differences in magnetic resonance imaging (MRI) findings after lumbar epidural nerve block using the transforaminal approach and the interlaminar approach in patients with low back pain. This study was an observational analysis study of abnormal findings of MRI after epidural nerve block. This study included 78 patients who underwent MRI at approximately 24 h after lumbar epidural nerve block at a pain clinic of a university hospital between January 2007 and December 2016. Among patients who received epidural nerve block, 36 used the interlaminar approach and 42 used the transforaminal approach. The incidence of patients with abnormal changes in MRI findings was higher among patients using the interlaminar approach (53%) than those using the transforaminal approach (7%). Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes, with epidural air being the most frequent abnormal finding (72%). We recommend use of the transforaminal approach to reduce the possibility of misreading or difficulty in interpretation of images of patients who underwent MRI at approximately 24 h after lumbar epidural nerve block. Practitioners should consider the possibility of abnormal findings such as epidural air on MRI in cases of epidural nerve block using the interlaminar approach.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.251-255
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• 1996

Headache after epidural block is the most frequent result of an unintentional dural puncture. This form of headache is usually caused by cerebrospinal fluid leakage through the dural puncture site. Another proposed cause of postdural puncture headache is the unintentional injection of air into the subarachnoid space. We experienced a case of severe headache with a patient after lumbar epidural block and discovered air in the intracranial subarachnoid space(pneumocephalus) with the aid of brain computerized tomography.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.73-76
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• 1997

Background : Epidural anesthesia is now accepted as a popular technique for pain relief and anesthesia. However, accidental dural puncture may occur during placement of the epidural needle. This study was undertaken to evaluate difference of the epidural depth between parturients and non-parturients. Method : Eighty non-parturients receiving epidural anesthesia were assigned to group I, and eighty parturients whose body weight had not yet increased over 15 kg from pregnancy were assigned to group II. With patients in lateral decubitus position, 18 guage Tuohy needle was punctured by approaching at $L_{3-4}$ interspace. Epidural space was identified using loss-of-resistance to air technique. Result : Epidural depth was 4.18 cm and 4.25 cm in group I and group II respectively. There was no significant statistical difference in body mass index(BMI) and ponderal index(PI) (p<0.05), nor in epidural depth between the two groups. Conclusion : Epidural needle need not be placed deeper in parturients than in nonparturients.