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At least 19 recordsLinked to original sources
PubMed1991

Percutaneous procedures for the diagnosis and treatment of lower back pain: diskography, facet-joint injection, and epidural injection.

This review discusses the indications, techniques, complications, and results of three percutaneous procedures used to evaluate and treat lower back pain: diskography, facet-joint injection, and epidural injection. Diskography, performed by injection of contrast medium into the nucleus pulposus, is a technique used to determine the cause of lower back pain in patients in whom findings on other imaging studies are normal or conflicting. Injection of steroids and anesthetic into the facet joints of the lumbar spine is useful to diagnose or treat patients with facet syndrome (back pain caused by abnormalities of the facet joints). Injection of steroids and anesthetic agents into the epidural space provides short-term relief, and can sometimes provide permanent relief, of lower back pain.

Anesthesia, Spinal↗
PubMed1984

Common bile duct pressure in dogs after opiate injection--epidural versus intravenous route.

The effect on the common bile duct pressure of epidurally injected morphine and fentanyl, was compared with that of intravenous injections of the same drugs in 12 mongrel dogs. Intravenous injection of morphine (0.1 mg X kg-1) or fentanyl (0.01 mg X kg-1) significantly elevated the common bile duct pressure from 10.48 +/- 0.37 to 21.68 +/- 0.33 cm H2O and from 9.66 +/- 0.33 to 14.14 +/- 0.21 cm H2O respectively. These increases occurred within 4-15 minutes after injection and lasted for about 2-3 hours. When the narcotics in identical dosages were injected epidurally, the common bile duct pressures were unchanged during the four hours of investigation. Further studies are planned to determine whether this beneficial effect of epidural narcotics applies also in the human clinical situation.

Animals↗
PubMed1987

Collagenase chemonucleolysis via epidural injection. A review of 252 cases.

Since 1975, collagenase has been injected into 252 herniated intervertebral discs for treatment of sciatica. Highly purified preparations of Chinese collagenase were extracted from Clostridium histolyticum CH 1093 in lyophylized form, which had a specific collagenolytic activity. It had a wide margin of safety as proven by repeated experiments in dogs by means of intradiscal, extradural, intradural, and intravenous injections. One hundred to two hundred units of collagenase dissolved in 5 ml of normal saline was injected epidurally in front of the line joining posterior vertebral body margins. The basic assumption is that the injected enzyme digested the nucleus pulposis. Symptoms disappeared or improved gradually within three to eight weeks. The total success rate was about 77%. For recurrent cases of those with less than satisfactory results, reinjections were performed without any visible antigenic reactions or neurologically adverse effects.

Adult↗
PubMedDate not supplied

Severe lumbar back pain following epidural injection of local anesthetic for epidural anesthesia. Case report and literature review.

BACKGROUND AND OBJECTIVES: An epidural anesthetic was planned for a 75-year-old man scheduled for elective femoral-popliteal bypass grafting. METHODS: Severe and persistent back pain and posterior thigh muscle spasm abruptly began 10 minutes after epidural injection of mepivacaine. RESULTS: Signs of impending or evolving neurologic injury completely resolved shortly thereafter. CONCLUSIONS: The worst case scenarios, epidural hematoma and unintentional epidural injection of an irritant, are discussed along with other differential diagnoses. The literature is reviewed to gain insight into this unusual clinical presentation.

Aged↗
PubMed1996

[The level of analgesia with epidural injection of 2% mepivacaine using combined spinal and epidural analgesia].

We studied the level of analgesia obtained with epidural injection of 2% mepivacaine using combined spinal and epidural analgesia (CSE) and compared with the level obtained by epidural analgesia (EA). We inserted a catheter into the epidural space through the L2/3 interspace, and hyperbaric tetracaine was injected through the L3/4 interspace with 26G spinal needle in thirty patients for CSE. We checked the the level of analgesia 90 min after spinal anesthesia. After this, 23 out of 30 patients showed the extension of analgesia 15 min after injection of mepivacaine into the epidural catheter. In these patients, the level of analgesia and the dose of mepivacaine showed the regression line Y = 10.2-0.4X (Y: the level of analgesia, X: the dose of 2% mepivacaine, P < 0.05). We also showed the regression line Y = 16.1-0.7X (P < 0.05) for EA 15 min after epidural injection of mepivacaine in other 23 patients. To achieve the same level of analgesia of Th8 or Th6 with CSE and EA, the doses for epidural injection were calculated as 5.5 ml, 10.5 ml with CSE and 11.5 ml, 14.4 ml with EA, respectively. These results show that the epidural dose of local anesthetic for CSE is 1/2 to 2/3 of that necessary for EA.

Adult↗
PubMed1991

[Accidental epidural injection of hypertonic sodium chloride solution].

Twenty ml of 20% hypertonic saline were accidentally injected into the epidural space of a 53-year-old man with lumbar backache and sciatica. This resulted in severe thoracolumbar pain, which disappeared after he received by the same route 20 ml of 1% lidocaine and 40 ml distilled water. Three months later, the sciatica had almost all disappeared; there remained no motor deficit. A literature survey helped to explain the signs described. Further cases of accidental epidural injections of other drugs are discussed.

Humans↗
PubMedDate not supplied

Cardiovascular effects after epidural injection of xylazine in isoflurane-anesthetized dogs.

The cardiovascular effects following epidural injection of xylazine or isotonic saline during isoflurane anesthesia were assessed in six healthy dogs. Dogs were anesthetized with isoflurane in O2 and maintained at 2.0% end-tidal concentration. Ventilation was controlled to maintain PaCO2 at 35 to 45 mm Hg. The dorsal pedal artery was cannulated for measurement of arterial blood pressure (AP)(systolic AP, mean AP, diastolic AP) and for blood sample collection. Arterial pH and blood gas tensions (PaO2 and PaCO2) were determined. Cardiac output was measured by thermodilution. The electrocardiogram (ECG), heart rate (HR), core body temperature, central venous pressure (CVP), mean pulmonary AP, and end-tidal isoflurane concentration (ETISO) and CO2 tension (ETCO2) were monitored. Systemic vascular resistance (SVR), arterial HCO2 concentration, base balance, and cardiac index (CI) were calculated. After baseline measurements were taken, either xylazine (0.2 mg/kg) in 5 mL isotonic saline or 5 mL of isotonic saline was injected into the lumbosacral epidural space. Data were then recorded at 5, 15, 30, 45, 60, 75, 90, 105, and 120 minutes after epidural injection. Data were analyzed by two-way analysis of variance (ANOVA) for repeated measures. When significant differences were encountered, mean values were compared using Bonferroni's test. The level of significance was set at P < .05. Mean values for diastolic AP decreased at 90 and 120 minutes compared with the mean value at 15 minutes after epidural injection of xylazine. No differences were detected at any time or between treatments for HR, systolic AP, mean AP, CVP, CI, SVR, mean pulmonary AP, temperature, ETCO2, ETISO, arterial pH, PaCO2, PaO2, plasma bicarbonate concentration, or base balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1995

[Epidural injection for postoperative pain relief after thoracoscopic surgery].

For the pain relief after thoracoscopic surgery, the epidural injection of buprenorphine was performed in 46 cases. In 28 cases, intermittent injection was performed before awaking from anesthesia. The effect was excellent in 6 cases, who were free from pain without any more injection after returning to the ward, and good in 27 cases, who sometimes felt dull pain and had another analgetics (intermittent epidural injection in 16 cases, intermittent epidural injection and another medication in 5 cases). In 18 cases, continuous injection was performed. The effect was excellent in 9 cases and good in 9 cases. It was concluded that the epidural injection had effective analgesic effect after thoracoscopic surgery, both in intermittent injection group and continuous injection group. For limited medication, the intermittent epidural injection was considered the first choice after thoracoscopic surgery.

Analgesia, Epidural↗
PubMed1991

The effect of a priming epidural injection of adrenaline on epidural blockade with bupivacaine.

Twenty-four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200,000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200,000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 micrograms adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. Mean maximum plasma concentrations of bupivacaine tended to be lower in the adrenaline groups. A delay in the time to peak plasma concentration of bupivacaine was noted in the A/B group; this indicated that priming with adrenaline may be effective at delaying early systemic uptake of the local anaesthetic. In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.

Anesthesia, Epidural↗
PubMed1987

Relief of low back pain by epidural injection. A case report.

This report describes the use of epidural injection in the treatment of a patient with severe back pain whose medical history and physical examination suggest a diagnosis of a lumbar disk lesion. The patient's medical history included recurrent episodes of buttock and hip pain that previously responded well to lumbar manipulation. On this occasion, the pain had become so severe that the patient could not tolerate manipulation. The patient's pain was relieved by administering an epidural injection of 50 cc of 0.5% procaine through the sacral hiatus. This injection has two relevant implications for the physical therapy profession. First, it offers a nonsurgical treatment for a lumbar disk lesion when physical therapy has been ineffective or is impractical. Second, in an appropriate clinical setting, the epidural injection provides an opportunity to understand more clearly the causes of back pain.

Adult↗
PubMed1988

Epidural injection of xylazine for perineal analgesia in horses.

Local anesthetics given in the epidural space of a horse may cause hind limb weakness in addition to analgesia. Because alpha 2 agonists given by epidural injection cause sensory blockade without motor effects in human beings and other species, their use in veterinary anesthesia is appealing. This study was designed to examine the effectiveness of xylazine HCl, an alpha 2 agonist commonly used in horses. Xylazine, 0.9% NaCl, and lidocaine were given by epidural injection to horses subjected to perineal electrical stimulation. Administration of xylazine (0.17 mg/kg of body weight, diluted to a 10-ml volume, using 0.9% NaCl) induced approximately 2.5 hours of local analgesia without apparent side effects. Higher doses of xylazine caused mild hind limb ataxia. Administration of lidocaine induced a similar duration of analgesia, with severe hind limb ataxia (100% incidence). We concluded that xylazine given by epidural injection results in safe, effective perineal analgesia in horses.

Analgesia, Epidural↗
PubMed1998

Arterial and pulmonary arterial concentrations of the enantiomers of bupivacaine after epidural injection in elderly patients.

UNLABELLED: Bupivacaine HCl is a 50:50 racemic mixture of the levo [S(-)] and dex [R(+)] enantiomers. The R(+) enantiomer exhibits greater cardiac tissue binding and toxicity. To determine whether the lung exhibits selective uptake of one of the enantiomers of bupivacaine, we measured pulmonary artery and radial artery blood concentrations of the two enantiomers after a lumbar epidural injection of 20 mL of 0.75% bupivacaine in 10 elderly patients undergoing one-stage bilateral total knee arthroplasty. Significantly lower concentrations of R(+) than S(-) were noted in both pulmonary artery and arterial blood. Both enantiomers were absorbed by the lung to a similar extent within the first 5 min after epidural injection (extraction ratio approximately equal to 0.1 or 10%). Mean time of maximal concentration (Tmax) was 6 min. In 3 of the 10 patients, Tmax occurred in 1-3 min. We conclude that the lung absorbs both the R(+) and S(-) enantiomers of bupivacaine to a similar extent after epidural injection and that this is of doubtful clinical significance. This study also suggests that peak concentrations of bupivacaine may occur earlier after epidural injection in certain elderly patients than previously believed. IMPLICATIONS: In the first 5 min after epidural injection, approximately 10% of the local anesthetic bupivacaine was absorbed by the lung. Absorption of the two enantiomers (mirror images) of bupivacaine were similar. Lung absorption of bupivacaine is unlikely to influence local anesthetic toxicity.

Absorption↗
PubMed1986

Distribution in cerebrospinal fluid, blood, and lymph of epidurally injected morphine and inulin in dogs.

We describe procedures for catheterizing the epidural space, the azygos vein, and the thoracic lymph duct of dogs without using fluoroscopy. The success rates of the procedures were 100, 80, and 50%, respectively (n = 10). To assess the validity of the model, 3H-morphine and unlabeled morphine (2 mg) were injected epidurally in ten dogs. Lumbar cerebrospinal fluid (CSF), azygos venous blood, arterial blood, and lymph were sampled before and 5, 20, 60, 120, 180, 240, 300 and 360 min after injection. During the first 20 min, morphine levels in the azygos vein were about three and ten times greater than arterial and lymphatic levels, respectively (n = 3; P less than 0.01). Morphine levels were significantly greater in the azygos vein (n = 8) and the femoral artery (n = 10) during the first 20 and 60 min than they were later, respectively (P less than 0.05). In the lymph (n = 5), the levels of morphine at 60 min were statistically greater (P less than 0.05) than levels at 4, 5, and 6 hr. At no time were the concurrent arterial and lymph levels different from each other. In the lumbar CSF, the morphine peak concentration was reached 5-60 min after epidural injection and ranged between 5 and 93 micrograms/ml. In the CSF, the levels of morphine were significantly greater during the first 20 min than later (n = 7; P less than 0.05). The washout of the lumbar CSF curve for morphine appeared to be fitted by a two-compartment open model. The t1/2-alpha and t1/2-beta values were 14.7 +/- 7.2 min and 106 +/- 45 min, respectively (mean +/- SD). Cumulative percentages of the epidural dose of morphine passed into the azygos system within the first 5, 20, 60, and 120 min after injection were calculated to be 4.0 +/- 2.1, 23.5 +/- 14.6, 49.2 +/- 34.2, and 55.9 +/- 35.3, respectively (mean +/- SD; n = 8). Both 14C-inulin and 3H-morphine were injected epidurally in one dog and intrathecally in another dog. In the CSF, morphine appears to be cleared at a rate similar to that of inulin. The fraction of morphine and inulin crossing the dura after epidural injection was calculated to be 0.31% and 0.59%, respectively.

Animals↗
PubMed1995

Results of epidural injection of local anaesthetic and corticosteroid in patients with lumbosciatic pain.

Epidural steroid therapy is one of the useful conservative modalities of treatment of low back pain with sciatica. Epidural injection of a mixture of 80 mg (2 ml) of methylprednisolone, 25 ml of normal saline and 10 ml of 2% lignocaine hydrochloride through sacral route produced excellent to good results in 83% of patients of low back pain with sciatica with subacute symptoms of less than 3 months duration, when evaluated after 3 months of injection. When evaluated after one year of injection the success rate came down to 64.8%.

Adult↗
PubMedDate not supplied

[Is epidural injection treatment with hypertonic saline solution in intervertebral disk displacement useful? (The effect of NaCl solution on intervertebral disk tissue)].

The effect of sodium chloride solution on disc tissue was investigated in vitro. Tissue material was obtained from 19 discectomies. The specimens were incubated in aqua ad injectionem and in different sodium chloride solutions and weighted regularly during a maximum of 24 hours. Following the incubation periods the specimens were examined histologically. After one hour the surgical specimens showed a weight increase of 290% for aqua bidest., 170% for 0.9% NaCl and 100% for 5.85% NaCl and 10% NaCl. Disc tissue obtained from six autopsies was also examined under the same conditions. The weight increase in nucleus pulposus and anulus fibrosus tissue was less than in the disc tissue obtained from surgery. The weight increase in anulus fibrosus tissue was less than in nucleus pulposus tissue. In vitro incubation of disc tissue in a hypermolar sodium chloride solution always resulted in a weight increase. Successful therapy could not be explained by shrinkage of disc tissue treated with hypermolar sodium chloride.

Adult↗