title: Ultrasound-aided unilateral epidural block for single lower-extremity pain.
abstract: We report an ultrasound-aided unilateral epidural block, employed in two patients, to provide better analgesia and motor function for lower-extremity pain. The patient in case 1 was a 72-year-old woman who suffered pain arising from Herpes zoster rash on the left leg (the second lumbar nerve area). A left-dominant continuous unilateral epidural block was performed to reduce her pain. After confirming the L2/3 epidural space and needle direction using ultrasound imaging, epidural cannulation was performed. Continuous infusion of 4 ml h(-1) of 1% lidocaine through the epidural catheter eliminated the herpetic pain in the left leg, maintaining motor function and normal sensation in her right leg. The patient in case 2 was a 35-year-old man whose complaint was postoperative pain in his left knee during passive movement. Dependent-side (left-side) dominant ultrasound-aided continuous unilateral epidural block, the same procedure as that used in case 1, was performed at the L3/4 intervertebral space. His left knee pain was clearly reduced, with partial paralysis, but motor function in his right leg was completely normal during the continuous epidural block with 4 ml h(-1) of 0.2% ropivacaine. Ultrasound imaging around the epidural space facilitated effective unilateral epidural block for single lower-extremity pain in both patients. This technique could decrease possible side effects and improve patient satisfaction during continuous nerve block by maintaining motor function and sensation in the nondependent side.
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kawaguchi
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Sugino
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
authors.forename: Eiji
authors.initials: E
authors.lastname: Honma
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Namiki
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local; D001182:Arthroscopy; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy; D006562:Herpes Zoster / Q000150:complications; D006801:Humans; D007717:Knee / Q000601:surgery; D008012:Lidocaine; D035002:Lower Extremity; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine