[Usefulness of radiologic monitoring of epidural catheters using epidurography].

INTRODUCTION

Peridural analgesia involves a segmental block which at the thoracic level allows for early pulmonary recovery after chest or high abdominal surgery. The approach is difficult in children for reasons related to anatomy, maintenance, insertion of the catheter and dosing.

OBJECTIVE

To report the radiologic monitoring of epidural catheter placement by epidurography as a technique for placing the epidural catheter in 17 patients for whom postoperative analgesia was to be provided by the same route.

PATIENTS AND METHODS

Eighteen children (aged from 2 to 12) were given general anesthesia followed by epidural anesthesia. After catheterization of the epidural space, 1 or 1-5 ml of contrast was injected. Immediately afterwards an X-ray of the thoracic or lumbar spinal column, as appropriate to each case, was obtained. Epidural analgesia was provided with a mixture of bupivacaine 0.125% and fentanyl, in continuous perfusion or in fractionated doses.

RESULTS

Placement of the catheter tip was confirmed in 17 cases by visualization of symmetry and the presence of contrast medium in the epidural space. In one case we observed extravasation of contrast medium, which had invaded the paravertebral space. The course was linear in 17 cases, with no looping. No complications related to injection of contrast medium were observed.

CONCLUSIONS

Epidurography provides objective monitoring of tip placement and trajectory of epidural catheters, advantages which argue in favor of more frequent application of this imaging technique.