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Lateral cervical epidural catheter placement using nerve stimulation for continuous unilateral upper extremity analgesia following a failed continuous peripheral nerve block
Author(s) -
Prusinkiewicz C.,
Lang S.,
Tsui B. C. H.
Publication year - 2005
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2005.00630.x
Subject(s) - medicine , dermatome , ropivacaine , anesthesia , fentanyl , catheter , surgery , tuohy needle , bolus (digestion) , nerve block , brachial plexus , interventional pain management , pain management , seldinger technique
This case report describes the application of electrical stimulation (Tsui test) to confirm placement of a cervical epidural catheter for postoperative pain management in a patient with a failed brachial plexus block who underwent upper extremity surgery. An epidural catheter was easily advanced under nerve stimulation guidance to the surgical dermatome C4 level without any resistance from the C7–T1 level. Successful analgesia was achieved with a bolus of 2 mg ml −1 ropivacaine 2 ml and fentanyl 20 µg, followed by a continuous infusion of 2 mg ml −1 ropivacaine with 2 µg ml −1 of fentanyl at a rate of 2 ml h −1 . This case reminds the clinician that cervical epidural analgesia may serve as an alternative to a difficult continuous peripheral nerve block. Electrical stimulation may also help to confirm cervical epidural catheter placement at the appropriate dermatome to provide effective analgesia with minimal side‐effects.