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  • Cervical Epidural Analgesia Via a Thoracic Approach Using Nerve Stimulation Guidance in an Adult Patient Undergoing Elbow Surgery

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Case reports
Cervical Epidural Analgesia Via a Thoracic Approach Using Nerve Stimulation Guidance in an Adult Patient Undergoing Elbow Surgery
  1. Ban C.H Tsui, B.Sc. (Pharm.), M.S.C., M.D., F.R.C.P.,
  2. Kendall Bateman, M.D.,
  3. Mart Bouliane, M.D., F.R.C.S. and
  4. Brendan Finucane, M.B., B.Ch., F.R.C.A., F.R.C.P.C.
  1. From the Department of Anesthesiology and Pain Medicine (B.C.H.T., K.B., B.F.), University of Alberta Hospitals, Edmonton, Alberta, Canada
  2. Department of Orthopedic Surgery (M.B.), University of Alberta Hospitals, Edmonton, Alberta, Canada
  1. Reprint requests: Ban C. H. Tsui, B.Sc. (Pharm.), M.S.C., M.D., F.R.C.P., Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 3B2.32 Walter Mackenzie Health Science Centre, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7. E-mail: btsui{at}ualberta.ca

Abstract

Objective This case report describes the placement of a cervical epidural catheter via the thoracic approach, using nerve stimulation, in a patient undergoing elbow surgery.

Case Report An epidural catheter was easily advanced to the C5 dermatome level from the T4-5 interspace, using nerve stimulation guidance. Successful perioperative analgesia was accomplished using an infusion of ropivacaine 0.2% with 0.05 mg/mL morphine at 4 mL/h.

Conclusions This case report suggests that electrical stimulation may allow one to accurately position epidural catheters in the central neuraxial space to provide reliable, effective analgesia of the upper extremity. This approach might be an alternative way to deliver cervical epidural analgesia for patients undergoing upper extremity surgery.

  • Cervical epidural analgesia
  • Thoracic epidural
  • Nerve stimulation test

https://doi.org/10.1016/j.rapm.2004.03.010

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    Footnotes

    • Supported in part by Education and Research Fund, Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Canada, and Clinical Investigatorship Award, Alberta Heritage Foundation for Medical Research, Alberta, Canada.

      The principal author has a patent license agreement with Arrow International Inc. for the epidural kit described in the article.