• The Korean Journal of Pain
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• 제22권2호
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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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• 제14권2호
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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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• 제23권3호
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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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• 제26권3호
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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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• 제22권2호
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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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• 제6권2호
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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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• 제30권4호
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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.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.317-323
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• 2017

본 연구의 목적은 요통으로 추간공 접근법과 추궁간판 접근법을 사용하여 요부 경막외 신경차단술을 받은 환자를 대상으로 시술 후 자기공명영상 소견이 어떻게 다른지 조사하는 것이었다. 연구 방법은 신경차단술 후 자기공명영상의 이상 소견에 대해 분석한 관찰 연구이다. 연구 대상자는 2007년 1월에서 2016 12월 사이에 일개 대학병원 통증클리닉에서 요부 경막외 신경차단술 24시간 후에 요추부 자기공명영상을 촬영한 78명의 환자를 대상으로 하였다. 신경차단술을 받은 대상자 중에서 추궁간판 접근법을 사용한 환자는 36명이었고, 추간공 접근법을 사용한 환자는 42명이었다. 경막외 신경차단술 후 자기공명영상에서 비정상적인 소견을 보인 환자들의 비율은 추간공 접근법을 사용한 군(7%)에 비해 추궁간판 접근법을 사용한 군(53%)에서 많았다. 비정상적인 자기공명영상 소견은 경막외 공기, 유체, 연부 조직의 변화, 바늘 자국 등이었다. 전체 비정상소견 중에서는 경막외 공기가 72%로 다수를 차지했다. 위의 연구결과를 고려할 때 요부 경막외 신경차단술을 시행 후 24시간 이내에 자기공명영상을 촬영할 경우에는, 시술 시 추간공 접근법을 이용하는 것이 자기공명영상의 판독 오류 또는 해석의 어려움을 줄이는데 도움이 될 것이다. 또한 추궁간판 접근법을 이용하여 시술하는 경우에는 자기공명영상에서 경막외 공기 등의 이상 소견이 발견될 가능성에 주의할 필요가 있다.

• The Korean Journal of Pain
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• 제9권1호
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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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• 제10권1호
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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.