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LETTER TO THE EDITOR

Is It Time to Perform All Thoracic Epidural Placements Under Fluoroscopy?

Department of Anesthesiology, SGPGIMS, Lucknow, India, mukesh_tripathi{at}yahoo.com

In Response:

I appreciate the interest of Dr. Narouze (1) regarding serious complications related to epidural block (2). I do not know how to resolve this safety concern, but I doubt that epidurography would improve safety. Even discounting the time and cost of the procedure, injury might still occur from direct needle trauma (3). If radio-opaque dye is inadvertently injected into the spinal cord, this might also cause severe injury.

I am unaware of any studies on the subject, but I expect that passing an epidural catheter would be difficult if the needle has partly entered the spinal cord. If so, then injection through an easily placed epidural catheter could represent a better option than direct injection through the epidural needle. Alternatively, electrical stimulation of the needle might be a better option than any form of injection (e.g., epidurography), as it should have less risk of direct cord damage.

References

1. Narouze SN. Is it time to perform all thoracic epidural placements under fluoroscopy? Anesth Analg 2006;102:1585.[Free Full Text]
2. Tripathi M, Nath SS, Gupta RK. Paraplegia after intracord injection during attempted epidural steroid injection in an awake patient. Anesth Analg 2005;101:1209–11.[Abstract/Free Full Text]
3. Tsui BCH, Armstrong K. Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient. Anesth Analg 2005;101:1212–4.[Abstract/Free Full Text]

This article has been cited by other articles:

				B. C. H. Tsui Is It Time to Perform All Thoracic Epidural Placements Under Fluoroscopy? Anesth. Analg., May 1, 2006; 102(5): 1586 - 1586. [Full Text] [PDF]

				M. Tripathi Epidural Steroid Injections After Epidurography May Prevent Otherwise Devastating Complications Anesth. Analg., May 1, 2006; 102(5): 1585 - 1585. [Full Text] [PDF]

				M. Tripathi Is It Time to Perform All Thoracic Epidural Placements Under Fluoroscopy? Anesth. Analg., May 1, 2006; 102(5): 1585 - 1586. [Full Text] [PDF]

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