Based on: Shaparin N, Jeffrey B, White RS, Kaufman AK. Bevel direction of epidural needles reliably predicts of catheter placement and
contrast in human cadavers: results of a pilot study. Jour of Clin Anestesia (2014) p1-4
NAVIGATION KEY
Introduction
Material &
Method
Result
Discussion
INTRODUCTION
In lower extremity surgery, direction of catheter
insertion influences the efficacy of epidural
anesthesia
Bevel direction in epidural spaces correlates
with the directional spread of injectate
When catheter placed bevel of needle facing
cephalad direction in the mid thoracic & low-thoracic
spine : injected contrast spread preferentially in
cephalad direction
Group 1
4 cadavers; needle bevel
direction cephaled
Group 2
4 cadavers; needle bevel
direction caudad
Continued
Gambar 2. Gaya gesek yang dihasilkan saat pasien berada di tempat tidur
(A) pada pinggul (B) pada tumit.2
Group 1: cephaled
Group 2: caudad
Inject 2 ml radiopage contrast (Omnipaque 300 GE Heathcare Inc. Priceton USA) &
obtain lumbar posteroanterior radiograph
Obtained direction of spread by remaining 1,8 mL contrast
RESULT
8 cadavers
Group 1: Cephaled
Excluded 1
cadaver due to
inability to access
epidural space
3 of 3 (100%)
flowed primarily
cephaled
direction
Group 2: Caudad
No excluded
Catheter tip direction according to the radiograph corresponded directly with bevel
direction
DISCUSSION
Better outcome than
GA for total hip
replacement surgery
Advantage
Improve early
rehabilitation after
mayor knee surgeries
Epidural
analgesia
Disadvanta
ge
Continued
DISCUSSION
Bevel orientation of
epidural needle
Tiso et al
Conflicting
result
Catheter placement
direction
Choi et al
28 patients, 3 cm lumbar
epidural anestesia
80% concordance catheter
direction cephaled group
46% concordance caudad
group
epidural anestesia
63% concordance cephaled
group
22% concordance caudad
group
Continued
DISCUSSION
Bevel orientation of
epidural needle
Hasnt
been
absolute &
conclusive
Direction of spread
of the injectate
Yokohama
et alsoft &
Young
patients have
dura
& aerolar tissue
loose
Lumbar
epidural
Park et al
3rd lumbar intervertebral
space anesthesia
correlate in patients >40
yo compared with 20 39
yo patients
No significant differences
in cephaled spread
between cephalad &
caudad group
Liu et al
20 patients for ankle
surgery/hemorhoidectomy
No significant differences
between groups in
characteristics of epidural
anesthesia (onset time,
duration, & anesthetic
level)
Continued
DISCUSSION
Bevel orientation of
epidural needle
Huffnangle et al
Bevel direction
cranial, caudal,
90right, 90left
lumbar region
Cephaled oriented
needle had
greatest success of
epidural analgesia
For sacral region,
mix cephaled &
caudad direction
preferable
Depending
level of
epidural
injection
Asato et al
Achieving effective
epidural analgesia
Chou et al
Caudad
direction
resulted faster
onset & greater
anestesia
Excluded 15%
catheter due to
poor placement
This study
Caudal plane
direction allow
decreased
volume of local
anestesia
Discussion
LIMITATION OF STUDY
7 subjects
Small
sample size
Use human
cadavers
Prone
position
May influence catheter
direction
Not feasible to place
cadavers sit/lateral decubitus
position
No study compared patients
position with ability thread
catheter & influence the
Discussion
CONCLUSION
This pilot study showed a strong relationship
between bevel orientation and catheter
direction
Catheter position does not reliably predict the
direction in which the injected fluid spreads in
all cadavers
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