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Ba-Shammakh SA, Al-Samnah AH, Qassim MW, Al-Shawabkeh AMBZ, Baamer QS. Unforeseen Complications: A Case of Subdural Anesthesia Post-epidural Insertion. Cureus 2023; 15:e45312. [PMID: 37846264 PMCID: PMC10577000 DOI: 10.7759/cureus.45312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Subdural anesthesia, although rare, is a significant complication of epidural anesthesia. This case report presents a 28-year-old female patient who developed sudden unconsciousness following epidural anesthesia administration for labor pain. Despite no evident contraindications to epidural anesthesia, she lost consciousness shortly after the initial test dose, leading to an emergency cesarean section under general anesthesia. The neonate showed signs of fetal bradycardia post-epidural and required intensive care. The patient made a complete recovery with no postpartum complications. This report underlines the need for vigilant monitoring and the importance of swift interventions in case of complications arising from epidural anesthesia.
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Affiliation(s)
| | - Ahmad H Al-Samnah
- Department of Anesthesiology and Reanimation, The Islamic Hospital, Amman, JOR
| | - Marah W Qassim
- Department of Anesthesiology and Reanimation, The Islamic Hospital, Amman, JOR
| | | | - Qobol S Baamer
- Department of Radiology, The Islamic Hospital, Amman, JOR
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2
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De Andres J, Hayek S, Perruchoud C, Lawrence MM, Reina MA, De Andres-Serrano C, Rubio-Haro R, Hunt M, Yaksh TL. Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient. FRONTIERS IN PAIN RESEARCH 2022; 3:900566. [PMID: 35782225 PMCID: PMC9246706 DOI: 10.3389/fpain.2022.900566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
Advances in our understanding of the biology of spinal systems in organizing and defining the content of exteroceptive information upon which higher centers define the state of the organism and its role in the regulation of somatic and automatic output, defining the motor response of the organism, along with the unique biology and spatial organization of this space, have resulted in an increased focus on therapeutics targeted at this extracranial neuraxial space. Intrathecal (IT) drug delivery systems (IDDS) are well-established as an effective therapeutic approach to patients with chronic non-malignant or malignant pain and as a tool for management of patients with severe spasticity and to deliver therapeutics that address a myriad of spinal pathologies. The risk to benefit ratio of IDD makes it a useful interventional approach. While not without risks, this approach has a significant therapeutic safety margin when employed using drugs with a validated safety profile and by skilled practioners. The present review addresses current advances in our understanding of the biology and dynamics of the intrathecal space, therapeutic platforms, novel therapeutics, delivery technology, issues of safety and rational implementation of its therapy, with a particular emphasis upon the management of pain.
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Affiliation(s)
- Jose De Andres
- Surgical Specialties Department, Valencia University Medical School, Valencia, Spain
- Anesthesia Critical Care and Pain Management Department, Valencia, Spain
- *Correspondence: Jose De Andres
| | - Salim Hayek
- Department of Anesthesiology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Christophe Perruchoud
- Pain Center and Department of Anesthesia, La Tour Hospital, Geneva, Switzerland
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Melinda M. Lawrence
- Department of Anesthesiology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Miguel Angel Reina
- Department of Anesthesiology, Montepríncipe University Hospital, Madrid, Spain
- CEU-San-Pablo University School of Medicine, Madrid, Spain
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
- Facultad de Ciencias de la Salud Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Ruben Rubio-Haro
- Anesthesia and Pain Management Department, Provincial Hospital, Castellon, Spain
- Multidisciplinary Pain Clinic, Vithas Virgen del Consuelo Hospital, Valencia, Spain
| | - Mathew Hunt
- Department of Physiology, Karolinska Institute, Stockholm, Sweden
| | - Tony L. Yaksh
- Departments of Anesthesiology and Pharmacology, University of California, San Diego, San Diego, CA, United States
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Barad M, Carroll I, Reina MA, Ansari J, Flood P. Did she have an epidural? The long-term consequences of postdural puncture headache and the role of unintended dural puncture. Headache 2021; 61:1314-1323. [PMID: 34570902 DOI: 10.1111/head.14221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This narrative literature review examines the long-term impact of postdural puncture headache (PDPH) in postpartum women following an unintended dural puncture (UDP) with a large bore needle commonly used for epidural catheter placement. It seeks to bridge the knowledge gap for the neurologist as to the mounting body of obstetric anesthesia literature on the development of chronic headache after PDPH with this unique needle. BACKGROUND Headache is the most common complication of dural puncture, and the risk is greatest in the parturient population. Preexisting risk factors for this population include youth and sex, and after UDP with a large bore needle, almost 70%-80% report a headache. Additionally, there appears to be a significant cohort who experience long-term, persistent headache after UDP. METHODS We performed a narrative review of literature using PubMed, searching terms that included long-term follow-up after UDP with a large bore needle in the postpartum population. RESULTS In women who had UDP with a large bore needle used for epidural catheter placement at delivery, the rate of chronic debilitating headache is around 30% in the months following delivery and may persist for up to a year or longer. CONCLUSION Based on the existing literature, we have mounting evidence that UDP with the large bore needle used to place an epidural catheter should be understood as a high-risk inciting event for the development of long-term headaches not simply a high risk of acute PDPH. Additionally, consideration should be given to stratifying the etiology of PDPH, based on needle type, and recognizing the entity of chronic PDPH, thus allowing for improvements in research and diagnosis.
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Affiliation(s)
- Meredith Barad
- Department of Anesthesiology, Perioperative Medicine and Pain, Stanford University, Stanford, California, USA
| | - Ian Carroll
- Department of Anesthesiology, Perioperative Medicine and Pain, Stanford University, Stanford, California, USA
| | - Miguel A Reina
- CEU San Pablo University School of Medicine, Madrid, Spain.,Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jessica Ansari
- Department of Anesthesiology, Perioperative Medicine and Pain, Stanford University, Stanford, California, USA
| | - Pamela Flood
- Department of Anesthesiology, Perioperative Medicine and Pain, Stanford University, Stanford, California, USA
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García-Vitoria C, García-Roselló M, Reina MA, De Andres J, Gutiérrez-Bautista ÁJ, Esteve V, Boezaart A, Redondo JI. Validation of a bioabsorbable device that seals perforations after Tuohy needle dural puncture in an ovine model. Reg Anesth Pain Med 2021; 46:389-396. [PMID: 33504475 DOI: 10.1136/rapm-2020-102225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We designed a device to close accidental dural puncture via the offending puncturing epidural needle directly after diagnosis of the puncture and before removing the needle. The aim of this study was to quantify this device's ability to seal cerebrospinal fluid leakage. METHODS Forty-six anesthetized adult sheep were studied in a single-blind randomized controlled fashion in two equal groups.An intentional dural puncture was performed with an 18-gage Tuohy needle on all the sheep between L6 and S1 levels. Contrast medium was injected through the needle. Twenty-three animals receive treatment with the sealing device. Two minutes after device placement, or dural puncture in the control group, a CT scan was performed on the animals to estimate contrast material leakage. A region of interest (ROI) was defined as the region that enclosed the subarachnoid space, epidural space, and neuroforaminal canal (the vertebral body above and half of its equivalent height in sacrum below the puncture site). In this region, the total contrast volume and the volumes in the epidural space (EPIDURAL) were measured. The primary outcome measure was the EPIDURAL/ROI ratio to ascertain the proportion of intrathecally injected fluid that passed into the epidural space in both groups. The secondary outcomes were the total amount of contrast in the ROI and the EPIDURAL. RESULTS The device was deployed successfully in all but two instances, where it suffered from manufacturing defects.Leakage was less in the study group (1.0 vs 1.4 mL, p=0.008). The median EPIDURAL/ROI ratio was likewise less in the study group (29 vs 46; p=0.013; 95% CI (-27 to -3.5)). CONCLUSION This novel dural puncture-sealing device, also envisaged to be used in other comparable iatrogenic leakage scenarios to be identified in the future, was able to reduce the volume of cerebrospinal fluid that leaked into the epidural space after dural puncture. The device is possibly a valuable way of preventing fluid leakage immediately after the recognition of membrane puncture.
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Affiliation(s)
- Carles García-Vitoria
- Department of Anesthesiology, Critical Care and Pain Management, Hospital Intermutual de Levante, San Antonio de Benagéber, Valencia, Spain
| | - Mireia García-Roselló
- Facultad de Veterinaria, CEU Universidad Cardenal Herrera, Valencia, Comunitat Valenciana, Spain
| | - Miguel A Reina
- Department of Anesthesiology, CEU-San Pablo University School of Medicine, Madrid, Spain
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Florida, Gainesville, Florida, USA
| | - Jose De Andres
- Anesthesia Unit - Surgical Specialties Department, University of Valencia, Valencia, Spain
- Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain
| | | | - Vicente Esteve
- Facultad de Veterinaria, CEU Universidad Cardenal Herrera, Valencia, Comunitat Valenciana, Spain
| | - Andre Boezaart
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Florida, Gainesville, Florida, USA
- Alon P Winnie Research Institute, Still Bay, Western Province, South Africa
| | - Jose I Redondo
- Departamento de Medicina y Cirugía Animal, CEU Universidad Cardenal Herrera, Moncada, Comunitat Valenciana, Spain
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Riquelme I, Reina MA, Boezaart AP, Tubbs RS, Carrera A, Reina F. Spinal arachnoid sleeves and their possible causative role in cauda equina syndrome and transient radicular irritation syndrome. Clin Anat 2021; 34:748-756. [PMID: 33449372 DOI: 10.1002/ca.23721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We have previously described arachnoid sleeves around cauda equina nerve roots, but at that time we did not determine whether injections could be performed within those sleeves. The purpose of this observational study was to establish whether the entire distal orifice of a spinal needle can be accommodated within an arachnoid sleeve. MATERIALS AND METHODS We carefully dissected the entire dural sacs off four fresh cadavers, opened them by longitudinal incision, and immersed them in saline. Under direct vision, we penetrated the cauda equina roots nerves traveling almost vertically downward at 30 locations each with a 27- and a 25-G pencil-point needle (60 punctures total). We captured the images with a stereoscopic camera. RESULTS The nerve root offered no noticeable resistance to needle entry. Although the arachnoid sleeves could not be identified with the naked eye, they were translucent but visible under microscopy. In 21 of 30 attempts with a 27-gauge needle, and in 20 of 30 attempts with a 25-gauge needle, the distal orifice of the spinal needle was completely within the arachnoid sleeve. CONCLUSION It seems possible to accommodate the distal orifice of a 25- or a 27-gauge pencil-point spinal needle completely within the space of the arachnoid sleeve. An injection within this sleeve could potentially lead to a neurological syndrome, as we have previously proposed.
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Affiliation(s)
- Irene Riquelme
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Miguel A Reina
- CEU-San-Pablo University School of Medicine, Madrid, Spain.,Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - André P Boezaart
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.,Alon P. Winnie Research Institute, Still Bay, Western Province, South Africa
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Anna Carrera
- Neuroscience, Embryology, Molecular Oncology and Clinical Anatomy Group (NEOMA), School of Medicine, University of Girona, Girona, Spain
| | - Francisco Reina
- Neuroscience, Embryology, Molecular Oncology and Clinical Anatomy Group (NEOMA), School of Medicine, University of Girona, Girona, Spain
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Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients? Pain Res Manag 2020; 2020:6015309. [PMID: 32831983 PMCID: PMC7428937 DOI: 10.1155/2020/6015309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
Objective In this study, considering the importance of platelet function in inflammatory processes, we explored whether there are relationships of platelet indices with postdural puncture headache (PDPH) and pain developing after use of spinal needles and whether patient characteristics contribute to the development of PDPH. Methods This prospective, observational study included 76 patients (Group 1) with PDPH and 93 patients (Group 2) without PDPH. The postoperative hemoglobin, hematocrit, platelet count (PC), and mean platelet volume (MPV) values were recorded, along with age, blood type, Rh factor, gravida, parity, and gestational age. In addition, the time of the onset of pain was recorded in patients who complained of a postspinal headache. Results Hemoglobin and hematocrit values in Group 1 were significantly lower than in Group 2 (both, p=0.024). The PC of Group 1 was significantly higher than that of Group 2 (p < 0.001), whereas the MPV was significantly lower (p < 0.001). The area under the curve (AUC) values were significant for hemoglobin, hematocrit, PC, and MPV (p=0.022, p=0.024, p < 0.001, and p < 0.001, resp.). For MPV, the AUC value was 0.293, sensitivity was 1%, and specificity was 99%. The highest likelihood ratio (LR+) value was 1.22 at a cut-off value of 13.3 fL. For the PC, the AUC value was 0.666, the sensitivity was 9%, and the specificity was 99%, while the highest LR + value was 8.56 at a cut-off value of 352 × 109/L. There was no significant relationship between the parameters examined and the onset of pain. Conclusion In this study, the PC was higher and MPV was lower in obstetric patients with PDPH compared with the control group. However, we also found that these two values cannot be used as markers of PDPH.
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7
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Fowler MJ, Cotter JD, Knight BE, Sevick-Muraca EM, Sandberg DI, Sirianni RW. Intrathecal drug delivery in the era of nanomedicine. Adv Drug Deliv Rev 2020; 165-166:77-95. [PMID: 32142739 DOI: 10.1016/j.addr.2020.02.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/17/2019] [Accepted: 02/28/2020] [Indexed: 12/23/2022]
Abstract
Administration of substances directly into the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord is one approach that can circumvent the blood-brain barrier to enable drug delivery to the central nervous system (CNS). However, molecules that have been administered by intrathecal injection, which includes intraventricular, intracisternal, or lumbar locations, encounter new barriers within the subarachnoid space. These barriers include relatively high rates of turnover as CSF clears and potentially inadequate delivery to tissue or cellular targets. Nanomedicine could offer a solution. In contrast to the fate of freely administered drugs, nanomedicine systems can navigate the subarachnoid space to sustain delivery of therapeutic molecules, genes, and imaging agents within the CNS. Some evidence suggests that certain nanomedicine agents can reach the parenchyma following intrathecal administration. Here, we will address the preclinical and clinical use of intrathecal nanomedicine, including nanoparticles, microparticles, dendrimers, micelles, liposomes, polyplexes, and other colloidalal materials that function to alter the distribution of molecules in tissue. Our review forms a foundational understanding of drug delivery to the CSF that can be built upon to better engineer nanomedicine for intrathecal treatment of disease.
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Affiliation(s)
- M J Fowler
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - J D Cotter
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - B E Knight
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America
| | - E M Sevick-Muraca
- Brown Foundation Institute of Molecular Medicine, Center for Molecular Imaging, Houston, TX 77030, United States of America
| | - D I Sandberg
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America; Department of Pediatric Surgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America; Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, United States of America
| | - R W Sirianni
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX 77030, United States of America.
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Reina MA, Boezaart A, De Andres-Serrano C, Rubio-Haro R, De Andrés J. Microanatomy Relevant to Intrathecal Drug Delivery. Methods Mol Biol 2020; 2059:109-120. [PMID: 31435917 DOI: 10.1007/978-1-4939-9798-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This chapter describes the microanatomy of the spinal cord that is relevant to intrathecal drug delivery started with covering of the spinal cord that are pierced to enter the intrathecal space. The dural sac is mostly constituted by the outer layer of dura and the inner layer called arachnoid membrane, which regulates diffusion of drugs into the intrathecal space. The pia matter surrounding the spinal cord is a permeable structure allowing the passage of drugs through intercellular spaces. The relationship between nerve roots, CSF, and subarachnoid catheters determines the passage of an intrathecal catheter which can cause damage to nerve roots and spinal cord. Multiple factors may be involved in the mechanisms of drug diffusion across the membranes of the spinal cord, as well as in their dilution with the CSF, which will lead to the final drug distribution and availability at nerve roots and the spinal cord.
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Affiliation(s)
- Miguel Angel Reina
- Unit of Anesthesia, Department of Clinical Medical Sciences, Institute of Applied Molecular Medicine, School of Medicine, University of CEU, San Pablo, Madrid, Spain. .,Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain.
| | - André Boezaart
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Rubén Rubio-Haro
- Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain
| | - José De Andrés
- Unit of Anesthesia, Department of Surgical Specialties, Valencia University Medical School, Valencia, Spain.,Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia, Spain
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The rising root sign: the magnetic resonance appearances of post-operative spinal subdural extra-arachnoid collections. Skeletal Radiol 2017; 46:1225-1231. [PMID: 28578526 DOI: 10.1007/s00256-017-2682-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 02/02/2023]
Abstract
We present a case series of symptomatic post-operative spinal subdural extra-arachnoid collections that displace the cauda equina roots anteriorly. This is described as the "rising root sign".
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Abstract
OBJECTIVES Intrathecal morphine (ITM) is an efficacious method of providing postoperative analgesia and reducing pain associated complications. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. Spine surgeons' reticence to make use of the technique may in part be attributed to concerns of precipitating a cerebrospinal fluid (CSF) leak. METHODS Herein we describe a method for oblique intrathecal injection during lumbar spine surgery to minimize risk of CSF leak. The dural sac is penetrated obliquely at a 30° angle to offset dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. RESULTS The technique was applied for injection of ITM or placebo in 104 cases of lumbar surgery in the setting of a randomized controlled trial. Injection was not performed in two cases (2/104, 1.9%) following preinjection dural tear. In the remaining 102 cases no instances of postoperative CSF leakage attributable to oblique intrathecal injection occurred. Three cases (3/102, 2.9%) of transient CSF leakage were observed immediately following intrathecal injection with no associated sequelae or requirement for postsurgical intervention. In two cases, the observed leak was repaired by sealing with fibrin glue, whereas in a single case the leak was self-limited requiring no intervention. CONCLUSIONS Oblique dural puncture was not associated with increased incidence of postoperative CSF leakage. This safe and reliable method of delivery of ITM should therefore be routinely considered in lumbar spine surgery.
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Liu W, Gu R, Zhu Q, Xiao C, Huang L, Zhuang X, Zhang J, Liu L, Ma B, Yang H, Ma J, Hu Z, Tang C, Zhao S, Chen X. Rapid fluorescence imaging of spinal cord following epidural administration of a nerve-highlighting fluorophore. Am J Cancer Res 2017. [PMID: 28638473 PMCID: PMC5479274 DOI: 10.7150/thno.18962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Iatrogenic spinal cord injury (SCI) is the most devastating complication of spine surgery, which usually results in permanent and serious disabilities of patients. Improvement of the visualization and discrimination of the spinal cord is critical for accuracy and safety during surgery; however, to date, there is no suitable technology to fulfill this clinical need. Here, we first show an efficient and rapid fluorescence imaging of the spinal cord in rabbit by epidural administration of a nerve-highlighting fluorophore, i.e. (E, E)-1,4-bis(p-aminostryl)-2-methoxy benzene (BMB). The BMB is firstly encapsulated into polymeric micelles to form a BMB-micelle (BMB-m) formulation with well-dispersion in normal saline solution. After epidural administration of BMB-m, BMB is transported by the flow of cerebrospinal fluid (CSF) and binds to the peripheral region of the white matter thus facilitating rapid staining of the spinal cord. Furthermore, this BMB imaging technology also holds great potential for visually monitoring the integrity of the spinal cord in real time and promptly identifying acute SCI during spine surgery.
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Rai SKR, Mancarella C, Goel AH. Brain Tumor Interface Dissection Technique with Surgical Blade from Laboratory to Neurosurgical Operating Room. World Neurosurg 2017; 100:601-606. [DOI: 10.1016/j.wneu.2017.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
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Deer TR, Pope JE, Hayek SM, Bux A, Buchser E, Eldabe S, De Andrés JA, Erdek M, Patin D, Grider JS, Doleys DM, Jacobs MS, Yaksh TL, Poree L, Wallace MS, Prager J, Rauck R, DeLeon O, Diwan S, Falowski SM, Gazelka HM, Kim P, Leong M, Levy RM, McDowell II G, McRoberts P, Naidu R, Narouze S, Perruchoud C, Rosen SM, Rosenberg WS, Saulino M, Staats P, Stearns LJ, Willis D, Krames E, Huntoon M, Mekhail N. The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation 2017; 20:96-132. [DOI: 10.1111/ner.12538] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Anjum Bux
- Anesthesia and Chronic Pain Management; Ephraim McDowell Regional Medical Center; Danville KY USA
| | - Eric Buchser
- Anaesthesia and Pain Management Department; EHC Hosptial, Morges, and CHUV University Hospital; Lausanne Switzerland
| | - Sam Eldabe
- The James Cook University Hospital; Middlesbrough UK
| | - Jose A. De Andrés
- Valencia School of Medicine; Hospital General Universitario; Valencia Spain
| | - Michael Erdek
- Anesthesiology and Critical Care Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| | | | - Jay S. Grider
- University of Kentucky College of Medicine, UK HealthCare Pain Services; Lexington KY USA
| | | | | | - Tony L. Yaksh
- Anesthesiology and Pharmacology; University of California; San Diego CA USA
| | - Lawrence Poree
- Pain Clinic of Monterey Bay, University of California at San Francisco; San Francisco CA USA
| | | | - Joshua Prager
- Center for the Rehabilitation Pain Syndromes (CRPS) at UCLA Medical Plaza; Los Angeles CA USA
| | - Richard Rauck
- Carolina Pain Institute, Wake Forest Baptist Health; Winston-Salem NC USA
| | - Oscar DeLeon
- Roswell Park Cancer Institute, SUNY; Buffalo NY USA
| | - Sudhir Diwan
- Manhattan Spine and Pain Medicine; Lenox Hill Hospital; New York NY USA
| | | | | | - Philip Kim
- Bryn Mawr Hospital; Bryn Mawr PA, USA
- Christiana Hospital; Newark DE USA
| | | | | | | | | | - Ramana Naidu
- San Francisco Medical Center, University of California; San Francisco CA USA
| | - Samir Narouze
- Summa Western Reserve Hospital; Cuyahoga Falls OH USA
| | | | | | | | | | - Peter Staats
- Premier Pain Management Centers; Shrewsbury NJ, USA
- Johns Hopkins University; Baltimore MD USA
| | | | | | - Elliot Krames
- Pacific Pain Treatment Center (ret.); San Francisco CA USA
| | - Marc Huntoon
- Vanderbilt University Medical Center; Nashville TN USA
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Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block. Reg Anesth Pain Med 2017; 42:709-718. [DOI: 10.1097/aap.0000000000000667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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VAN ZUNDERT AAJ, REINA MA, LEE RA. Prevention of post-dural puncture headache (PDPH) in parturients. Contributions from experimental research. Acta Anaesthesiol Scand 2013; 57:947-9. [PMID: 23701277 DOI: 10.1111/aas.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - M. A. REINA
- CEU San Pablo University School of Medicine; Madrid; Spain
| | - R. A. LEE
- Technical University of Delft; Delft; The Netherlands
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Reina MA, Andrés JA, Hernández-García JM, Arriazu-Navarro R, Durán-Mateos EM, Prats-Galino A. Successive changes in extraneural structures from the subarachnoid nerve roots to the peripheral nerve, influencing anesthetic block, and treatment of acute postoperative pain. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2011.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Transforaminal or translaminar approach for dorsal root ganglion and dorsal nerve root. Anatomical reason for technique decision. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2010.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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