Rocco A G, Reisman R M, Lief P A, Ferrante F M
Pain Treatment Service, Brigham and Women's Hospital, Boston, MA 02115.
Reg Anesth. 1989 Mar-Apr;14(2):85-7.
Traditional techniques of epidural needle placement have not proved satisfactory in patients who have had a previous laminectomy and may have epiduroarachnoiditis. A two-person technique was developed to: 1) simplify performance of difficult, epidural needle placement; 2) allow both resident and staff a simultaneous "hands-on" teaching experience; 3) allow a painless method of medication administration in patients with altered epidural anatomy; and 4) allow a simple method for determination of epidural space pressures. A glass syringe and extension tubing filled with saline are connected to the epidural needle. The needle is advanced by the operator while the pressure is monitored by the assistant. Once in the epidural space, the extension tubing is held vertically to act as a manometer. The column of saline falls and fluctuates with heart beat, providing verification of correct needle placement. Medication is placed in the barrel of the syringe and allowed to infuse by gravity. The two-person technique has achieved both patient and resident acceptance, and allows a painless method of medication administration in patients with altered epidural space anatomy.
