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Differential Epidural Block
  1. Rom A. Stevens, M.D.*,
  2. Tzu-Cheg Kao, PH.D.,
  3. Jack G. Bray, M.D.*,
  4. Loren Spitzer, C.R.N.A. and
  5. James D. Artuso, M.D.*
  1. Presented in abstract form at the annual meeting of the American Society of Regional Anesthesia, Cincinnati, April 4-7, 1991.
  2. From the Department of Anesthesiology, National Naval Medical Center, and the Departments of Anesthesiology and Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
  3. *Assistant Professor of Anesthesiology.
  4. Assistant Professor of Preventive Medicine (Biometrics).
  5. Staff Nurse Anesthetist.
  1. Address correspondence and reprint requests to Rom A. Stevens, M.D., Department of Anesthesiology, The Medical College of Wisconsin, 7700 W. Wisconsin Ave., Milwaukee, WI 53266.


Background and Objectives. Loss of sensation to pinprick and cold are commonly used to test the extent of epidural anesthesia. To see what difference exists between the level of epidural block determined by various sensory modalities, we performed this study in ten volunteers using epidural anesthesia with plain 3% chloroprocaine hydrochloride.

Methods. Four injections of chloroprocaine were made via an epidural catheter inserted at L2-3 with increasing larger volumes. Sensory modalities tested were (1) absence of sensation when tested by pinprick (anesthesia), (2) loss of a sharp sensation compared to an unblocked dermatome when tested by pinprick (analgesia), and (3) loss of cold sensation when tested with an alcohol swab compared to an unblocked dermatome.

Results. At 20 minutes after each injection the level of anesthesia was found to be most caudad and the level of analgesia most cephalad. The zone of differential block was greater than four dermatomes at the highest level of block tested. The level of loss of cold sensation was found between the other two levels. Differences between the levels of analgesia and cold sensation tended to be greater with more extensive block. Differences between levels of anesthesia and cold sensation did not significantly change as the extent of epidural anesthesia was increased.

Conclusions. This study establishes the existence of a differential epidural anesthesia during high thoracic block with chloroprocaine and suggests that the intensity of block diminishes as distance from site of injection increases.

  • Anesthesia techniques
  • epidural
  • anesthetics
  • local
  • chloroprocaine
  • differential block.

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  • Supported by Health Sciences Education and Training Command grant no. 89-06-2611-00.

    The opinions expressed in this article are those of the authors and do not reflect official policy of the Navy Medical Department or of the Department of Defense.

    The authors thank Professor Philip Bromage, Professor Kamran Samii, and Dr. William Urmey for their kind review of this manuscript.