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Anesth Analg 2008; 107:708-721
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31817e7065
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 Course on Factors Affecting the Spread of Epidural Anesthesia
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ANALGESIA

Factors Affecting the Distribution of Neural Blockade by Local Anesthetics in Epidural Anesthesia and a Comparison of Lumbar Versus Thoracic Epidural Anesthesia

W. Anton Visser, MD, PhD*, Ruben A. Lee, BE(Hons){dagger}, and Mathieu J. M. Gielen, MD, PhD{ddagger}

From the *Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, Breda; {dagger}Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Technical University of Delft, Delft; and {ddagger}Department of Anesthesiology, University Medical Center Nijmegen, Nijmegen, The Netherlands.

Address correspondence to W. Anton Visser, MD, Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands. Address e-mail to avisser{at}amphia.nl.

Abstract

The spread of sensory blockade after epidural injection of a specific dose of local anesthetic (LA) differs considerably among individuals, and the factors affecting this distribution remain the subject of debate. Based on the results of recent investigations regarding the distribution of epidural neural blockade, specifically for thoracic epidural anesthesia, we noted that the total mass of LA appears to be the most important factor in determining the extent of sensory, sympathetic, and motor neural blockade, whereas the site of epidural needle/catheter placement governs the pattern of distribution of blockade relative to the injection site. Age may be positively correlated with the spread of sensory blockade, and the evidence is somewhat stronger for thoracic than for lumbar epidural anesthesia. Other patient characteristics and technical details, such as patient position, and mode and speed of injection, exert only a small effect on the distribution of sensory blockade, or their effects are equivocal. However, combinations of several patient and technical factors may aid in predicting LA dose requirements. Based on these results, we have also formulated suggested epidural insertion sites that may optimize both analgesia and sympathicolysis for various surgical indications.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.