Cervical epidural analgesia via a thoracic approach using nerve stimulation guidance in an adult patient undergoing elbow surgery.
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.


METHODS
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.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Alberta, Canada. btsui@ualberta.ca
Ban C H
BC
Tsui
Kendall
K
Bateman
Mart
M
Bouliane
Brendan
B
Finucane
D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D015360:Analgesia, Epidural / Q000295:instrumentation / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002574:Cervical Vertebrae; D004550:Elbow / Q000601:surgery*; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000517:prevention & control; D000077212:Ropivacaine; D013904:Thoracic Vertebrae
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine