Disease relevance of Epidural Space

• The epidural space around the lumbar segments with induced ischemia was continually perfused with cold (5 degrees C) isotonic saline via two communicating spinal canal openings [1].
• PROCEDURE: Each mare received detomidine hydrochloride (0.06 mg/kg of body weight), administered in the caudal epidural space, followed 61 minutes later by yohimbine (0.05 mg/kg; test) or sterile saline (0.9% NaCl) solution (control), administered i.v., in a randomized, crossover study design with > or = 2 weeks between treatments [2].
• Blood patches may carry a higher risk of serious complications after multiple epidural phenol injections because of fibrosis and obliteration of the epidural space [3].
• Absorption of clonidine from the epidural space into the blood is very rapid and may contribute to the hypotension that occurs [4].
• OBJECTIVE--To examine effects of 0.25 mg of xylazine/kg of body weight diluted to a total volume of 6 ml/450 kg with sterile 0.9% NaCl, administered into the epidural space of the sacrococcygeal joint on perineal analgesia, sedation, ataxia, and respiratory and cardiovascular function in standing mares [5].

High impact information on Epidural Space

• Patients who received epidural morphine required less parenteral morphine in the 24 hours following surgery, had lower analogue pain scores, and had markedly lower plasma norepinephrine levels when compared with patients in the control group who received an identical volume of saline in the epidural space [6].
• For standard epidural analgesia, 25 mg (10 mL of 0.25%) bupivacaine was injected into the epidural space, followed by top-ups of 6-10 mL 0.25% bupivacaine, as required [7].
• In contrast, injections of mepivacaine into epidural space suppressed pain and movements in all patients [8].
• The cervical epidural space was injected (C7-D1; 18-ga needle) with an increasing volume (10 ml maximum) of isotonic saline solution to exacerbate the patient's radicular pain [9].
• The mean volume injected in the epidural space was: 6.6 +/- 2.1 and 6.3 +/- 1.9 ml in groups S and S + M, respectively, and this volume exacerbated pain in 21 of 24 patients [9].

Chemical compound and disease context of Epidural Space

• We report the conservative treatment of a spinal epidural abscess (SEA) caused by escherichia coli and affecting the anterior epidural space from C2 to L4 in a diabetic, obese patient presenting with tetraparesis [10].
• Injection of 2 mg/kg of ketamine in 1 mL saline/4.5 kg body weight was then performed at the lumbosacral epidural space [11].

Biological context of Epidural Space

• In all patients 12.5 ml of 2% lidocaine HCl was injected into the lumbar epidural space, and systolic and diastolic blood pressures, and heart rate were continuously monitored [12].
• CONCLUSIONS: In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block [13].
• However, because drug concentration in the epidural space has never been measured, our understanding of the effect of epinephrine on epidural pharmacokinetics is incomplete [14].
• DISCUSSION: Kinetics studies showed that multivesicular liposome sequestration results in a restrained and persistent release of morphine from the epidural space [15].
• Uncontrolled clinical observations that bupivacaine injected into the epidural space causes faster recovery of bowel motility after various abdominal operations led us to assess the hypothesis that epidural anesthesia can hasten the recovery of gastrointestinal motility in the immediate postischemic period [16].

Anatomical context of Epidural Space

• CONCLUSIONS: Radicular artery blood supply does not redistribute fentanyl from the epidural space to the spinal cord in this model [17].
• If so, then the spinal meninges may have an important impact in limiting the bioavailability of epinephrine in both the spinal cord and epidural space [18].
• However, the rate of vascular absorption of lidocaine from the subarachnoid space was significantly slower than from the epidural space [19].
• Using a strict midline approach, one cannot therefore rely on the ligamentum flavum to impede entering the epidural space in all patients [20].
• This connection fixed the dura mater to the flaval ligaments and also narrowed the epidural space in the midline [21].

Associations of Epidural Space with chemical compounds

• We report a case of epidural haematoma following a steroid injection into the cervical epidural space [22].
• The initial transfer of sufentanil from the epidural space to the systemic circulation appeared to be very rapid [23].
• It follows that an injection of methylprednisolone acetate into the epidural space does not guarantee that it will remain isolated there [24].
• Magnetic resonance (MR) imaging with gadolinium diethylenetriaminepentaacetic acid (DTPA) was performed in 12 patients with neoplasia of the spine and epidural space [25].
• Metrizamide, a non-ionic water-soluble contrast agent, was injected into the epidural spaces of 6 dogs to see if the posterior border of the L7-S1 interspace could be outlined [26].

Gene context of Epidural Space

• The positive rate for both MMP-7 and MMP-8 significantly increased when HNP was exposed to the epidural space (p < 0.01) [27].
• METHODS: In 39 patients undergoing abdominal surgery, the cutaneous distance between the L4-L5 and T10-T11 interspaces was measured, and an appropriate length of 19-G catheter was inserted into the epidural space through an 18-G Tuohy needle with bevel directed cephalad [28].
• During voluntary contraction, the calculated CMCT (4.9 +/- 1.0 ms) was the same as the onset latency of the second component of the ESCPs (I-wave, 4.3 +/- 0.2 ms) recorded from the C6-C6/7 epidural space [29].
• When disk fragments moved in a superior (42%) or inferior (40%) direction from the donor disk, the displaced disk components were most frequently (94%) dislodged into the right or left half of the anterior epidural space (AES) and rarely straddled the midline [30].
• The transfer of sufentanil from the epidural space into the CSF is slower than the transfer into the plasma and it varied interindividually [23].

Analytical, diagnostic and therapeutic context of Epidural Space

• Group 1 patients (n = 6) received 8 ml of 0.5% plain bupivacaine in the epidural space (L3-4) (mean upper level of analgesia at T10) [31].
• There appears little justification for the use of the generally less familiar, and potentially more dangerous, thoracic approach when fentanyl alone is infused into the epidural space following thoracotomy [32].
• This was to determine the effect on gastric motility of the addition of fentanyl to a solution of local anaesthetic given into the epidural space to provide pain relief following Caesarean section [33].
• MEPs were elicited with transcranial electrical stimulation and recorded from the spinal epidural space (D wave) or peripheral muscles (myogenic MEP) [34].
• CONCLUSIONS: The gross dissection demonstrated that both thicknesses of resorbable PLA barrier films created a controlled dissection plane, facilitated access to the epidural space, and provided a reduction in the tissue adherent to the dura [35].

References