Tomomi Sano

Successful treatment of epidural abscess with a percutaneously introduced 4-French catheter for drainage

W ith the recent improvements in antibiotics, conservative therapy for epidural abscess in the early stage has been reported to be effective (l-4). However, epidural abscesses are often difficult to treat, and surgery may be necessary. In the case described herein, we successfully treated an epidural abscess that developed in the course of continuous epidural block by continuous drainage through a percutaneously introduced 4-French catheter.

Five cases of far lateral lumbar disc herniations treated conservatively

Abstract Far lateral lumbar disc herniation (FLLDH) compresses the nerve root or dorsal ganglion outside the spinal canal at the same level of the herniation and produces severe pain on the anterolateral thigh. Computed tomography or magnetic resonance imaging (MRI) allow successful diagnosis of FLLDH, though one-third of FLLDH is still overlooked at the initial examination. There have been few reports about conservative therapies for FLLDH. We describe five cases of FLLDH treated recently with success using several kinds of nerve blocks. All the cases complained of severe pain at the gruteal or anterolateral part of lower extremity and four of them could not walk because of pain. The axial view of MRI was useful for the diagnosis of FLLDH. Neither lumbar epidural block nor the root block were effective for pain reduction. However, puncturing of herniated mass using a block needle, and a subsequent interdiscal injection of a steroid and a local anesthetic decreased pain in all cases. FLLDH should be taken...

Neurological and histopathological effects of epidural phenol neurolysis in the rabbit

Abstract Objectives: Epidural phenol neurolysis for severe cancer pain has been linked to complications such as paraplegia and urinary incontinence. Given the ease of administration of epidural injections, proof of the safety and efficacy of epidural phenol injection would increase the popularity of this procedure for cancer pain relief. This study was conducted to evaluate the analgesic effects and histopathological changes in the spinal nervous system of rabbits after epidural administration of phenol. Materials and methods: Under pentobarbital anesthesia, percutaneous epidural catheterization at the level of the L6–L7 lumbar interspace was conducted in 16 rabbits. After epidurography using 0.3 ml of iopamidol, 0.3 ml of 7% phenol in saline was injected through the catheter into the epidural space of 15 rabbits, and 0.3 ml saline was epidurally injected in one rabbit serving as control. Motor function and analgesia were investigated on days 1 and 14. On day 14, the spinal cords were resected and process...

Bacterial contamination of epidural needles and catheters

Abstract Background: We estimated the possibility of bacterial contamination of the epidural space during catheterization. We prospectively investigated the incidence of bacterial contamination of the tips of epidural needles and indwelling epidural catheters, and also of disinfected skin at puncture sites. Methods: One hundred pain clinic patients received a total of 110 continuous epidural blocks. After local preparation with 0.5% chlorhexidine ethanol, the skin was swabbed with a small piece of saline-soaked cotton gauze for bacterial examination of the puncture site. The epidural space was punctured with an 18-G Tuohy needle, followed by placement of an epidural catheter. The tip of the needle was cut immediately after removal and incubated for bacterial examination. The tip of the indwelling catheter was also cut and incubated after removal. Bacteria in all samples were examined at the clinical laboratory in our institute. Results: The incidence of bacteriological contamination was as follows: 9 (8.2...