A surgically placed epidural catheter in a patient with spinal trauma.
OBJECTIVE
To report the successful perioperative anaesthetic and analgesic management of a spinal trauma patient with a surgically placed epidural catheter.


METHODS
A 15-yr-old adolescent woman sustained an unstable spinal column injury with an incomplete neurological deficit following a high speed motor vehicle accident. She was scheduled for spinal decompression and stabilisation through a left thoracoabdominal approach. Balanced general anaesthesia was undertaken. Prior to closure, a multi-orifice epidural catheter was surgically placed under direct vision 5 cm into the anterior epidural space. The catheter was then tunnelled out through the psoas muscle and secured in place. Combined epidural-general anaesthesia was then initiated for the duration of the case using 5 ml bupivacaine 0.25% after an initial test dose of 3 ml lidocaine 1.5% with epinephrine. An infusion of bupivacaine 0.10% and fentanyl 5 micrograms.ml-1 at 8 ml.hr-1 using patient controlled epidural analgesia (PCEA) provided excellent postoperative pain control for four days. She had an uncomplicated postoperative course.


CONCLUSIONS
A surgically placed epidural catheter provided excellent, safe, perioperative anaesthesia and analgesia in this patient with unstable spinal trauma.
Seal
D D
DD
Department of Anaesthesia 1, Foothills Hospital, University of Calgary, Alberta.
Loken
R G
RG
Hurlbert
R J
RJ
D000063:Accidents, Traffic; D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy; D013117:Spinal Cord Compression / Q000150:complications* / Q000601:surgery
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine