Local and Regional Anaesthesia
Background and Goal of Study: The loss-of-resistance method sometimes results in difficulty identifying the epidural space, particularly in obese or elderly patients. We developed a new method to confirm epidural puncture by changing epidural pressure (EP) using the Queckenstedt-Stookey test procedure (QST), which increases subarachnoid pressure by pressing the internal jugular vein. The present study evaluated the reliability of this new method.
Materials and Methods: The new method was examined in 30 patients who underwent cervical decompression surgery for cervical myelopathy or ossification of the posterior longitudinal ligament. All patients displayed spinal canal stenosis and received EP monitoring with the QST through a Touhy needle for electrode catheterization at T10-L2 for orthopedic diagnosis. Epidural catheterization was confirmed by electric stimulation (5 mA, 2 Hz) and postoperative radiography. In addition, 50 patients who underwent celiotomy or thoracotomy also received EP monitoring with the QST to confirm epidural puncture for catheterization at T5-L5. Changes in EP were recorded during the QST, and epidural catheterization was confirmed by perioperative analgesic effects and postoperative radiography.
Results and Discussions: Increased EP during the QST was clearly observed in 30 orthopedic patients (mean ΔEP: 5 ± 3 mmHg; range 2-10 mmHg), and the electrode in the epidural space was detected by electrical stimulation and radiography. In the 50 cases of celiotomy or thoracotomy, increased EP and epidural catheterization were observed in 49 patients (mean ΔEP: 4 ± 2 mmHg; range 2-11 mmHg), although no change in EP was observed in 1 case with the catheter tip in the thoracic cavity.
Conclusion(s): EP monitoring combined with the QST could offer a good method for confirming epidural puncture when results from the loss-of-resistance method are unclear.