P046: ALGORITHM FOR DIFFICULT EPIDURAL PLACEMENT
Vadim Katsenovich, DO, Barys Ihnatsenka, MD, Yury Zasimovich, MD, Linda Le-Wendling, MD, Cameron Smith, MD, PhD, Olga Nin, MD, Erik Helander, MBBS; University of Florida
Epidurals can be used for a wide range of surgical procedures and labor to relieve pain, reduce patient suffering and decrease opioid consumption. The loss of resistance (LOR) technique to access the epidural space was first described in 1921 and is still the primary method used today. Despite the widespread use of epidurals, significant failure rates of 32% and 27% for thoracic and lumbar epidurals have been reported (1). Correct placement of an epidural catheter is paramount for it’s success. Difficult access to the epidural space requiring multiple attempts is associated with increased pain and discomfort, and may increase the risk of long-term complications (2). At the University of Florida thoracic epidurals are the analgesic modality of choice for post-operative pain control in a wide variety of surgeries including: whipples, open and laparoscopic colorectal surgery, cystectomies, and open and video-assisted thoracoscopic lung surgery. Thus thoracic epidurals are undertaken on a daily basis with some patients having significant risk factors for difficult epidural access. Here we present an algorithm created through information gathered using the electronic database PubMed and expert opinion, to assist in the approach and decision-making during difficult epidural placement.
1. Elsharkawy H, Sonny A, Chin KJ. Localization of epidural space: A review of available technologies. J Anaesthesiol Clin Pharmacol. 2017;33(1):16-27.
2. Ruzman T, Gulam D, Harsanji Drenjancevic I, Venzera-Azenic D, Ruzman N, Burazin J. Factors associated with difficult neuraxial blockade. Local Reg Anesth. 2014;7:47-52.