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REGIONAL ANESTHESIA

Continuous Positive Airway Pressure Breathing Increases the Spread of Sensory Blockade After Low-Thoracic Epidural Injection of Lidocaine

W. Anton Visser, MD^*, Mathieu J. M. Gielen, MD, PhD, and Janneke L. P. Giele, MSci

*Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, Breda, The Netherlands; Department of Anesthesiology, University Medical Center Nijmegen, Nijmegen, The Netherlands; and Department of Anesthesiology, University Medical Center Nijmegen, HB Nijmegen, The Netherlands

Address correspondence to W. Anton Visser, MD, Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands. Address e-mail to avisser{at}amphia.nl. Reprints will not be available from the authors.

Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the T7-8 or T8-9 intervertebral space into 2 groups. The control group (n = 10) received an epidural test dose of 4 mL lidocaine 2% during spontaneous breathing at ambient pressure. The continuous positive airway pressure (n = 10) group received the same epidural test dose but during spontaneous respiration with 7.5 cm H₂O continuous positive airway pressure. The groups were comparable with respect to demographic variables. Fifteen minutes after the conclusion of the epidural injection, the sensory block ranged from from T4 [median, interquartile range 2.75 segments] to T11 (interquartile range 3.5 segments) in the control group and from T5 (interquartile range 2.25 segments) to L2 (IQR 2.25 segments) in the continuous positive airway pressure group (P = 0.005 for the caudal border). The total number of segments blocked was 7 (median, interquartile range 2.25) in the control group and 11 (interquartile range 3.5) in the continuous positive airway pressure group (P = 0.004). The number of segments blocked caudad to the injection site was 3 (median, interquartile range 3.5) in the control group and 6 (interquartile range 2.25) in the continuous positive airway pressure group (P = 0.005). We conclude that continuous positive airway pressure increases the spread of sensory blockade in thoracic epidural anesthesia, primarily by a more caudad extension of sensory blockade.

This article has been cited by other articles:

				W. A. Visser, R. A. Lee, and M. J. M. Gielen Factors Affecting the Distribution of Neural Blockade by Local Anesthetics in Epidural Anesthesia and a Comparison of Lumbar Versus Thoracic Epidural Anesthesia Anesth. Analg., August 1, 2008; 107(2): 708 - 721. [Abstract] [Full Text] [PDF]

				W. A. Visser, M. J. P. G. van Eerd, R. van Seventer, M. J. M. Gielen, J. L. P. Giele, and G. J. Scheffer Continuous Positive Airway Pressure Breathing Increases Cranial Spread of Sensory Blockade After Cervicothoracic Epidural Injection of Lidocaine Anesth. Analg., September 1, 2007; 105(3): 868 - 871. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999