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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)
MeSH Review

Epidural Space

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Disease relevance of Epidural Space


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


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


Associations of Epidural Space with chemical compounds


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


  1. Epidural perfusion cooling protection against protracted spinal cord ischemia in rabbits. Vanický, I., Marsala, M., Gálik, J., Marsala, J. J. Neurosurg. (1993) [Pubmed]
  2. Effects of intravenously administered yohimbine on antinociceptive, cardiorespiratory, and postural changes induced by epidural administration of detomidine hydrochloride solution to healthy mares. Skarda, R.T., Muir, W.W. Am. J. Vet. Res. (1999) [Pubmed]
  3. Spinal subdural haematoma as a complication of immediate epidural blood patch. Tekkök, I.H., Carter, D.A., Brinker, R. Canadian journal of anaesthesia = Journal canadien d'anesthésie. (1996) [Pubmed]
  4. Pharmacokinetics of clonidine after epidural administration in surgical patients. Lack of correlation between plasma concentration and analgesia and blood pressure changes. van Essen, E.J., Bovill, J.G., Ploeger, E.J., Houben, J.J. Acta anaesthesiologica Scandinavica. (1992) [Pubmed]
  5. Analgesic, hemodynamic, and respiratory effects of caudal epidurally administered xylazine hydrochloride solution in mares. Skarda, R.T., Muir, W.W. Am. J. Vet. Res. (1996) [Pubmed]
  6. Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity. Breslow, M.J., Jordan, D.A., Christopherson, R., Rosenfeld, B., Miller, C.F., Hanley, D.F., Beattie, C., Traystman, R.J., Rogers, M.C. JAMA (1989) [Pubmed]
  7. Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Collis, R.E., Davies, D.W., Aveling, W. Lancet (1995) [Pubmed]
  8. Lumbar epidural block for 'painful legs and moving toes' syndrome: a report of three cases. Okuda, Y., Suzuki, K., Kitajima, T., Masuda, R., Asai, T. Pain (1998) [Pubmed]
  9. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Castagnera, L., Maurette, P., Pointillart, V., Vital, J.M., Erny, P., Sénégas, J. Pain (1994) [Pubmed]
  10. Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of the literature. Wessling, H., de las Heras, P. Neurocirugía (Asturias, Spain) (2003) [Pubmed]
  11. Hemodynamic effects of epidural ketamine in isoflurane-anesthetized dogs. Martin, D.D., Tranquilli, W.J., Olson, W.A., Thurmon, J.C., Benson, G.J. Veterinary surgery : VS : the official journal of the American College of Veterinary Surgeons. (1997) [Pubmed]
  12. Abnormalities in myocardial segmental wall motion during lumbar epidural anesthesia. Saada, M., Duval, A.M., Bonnet, F., Rey, B., Castillon, G., Macquin-Mavier, I., Cabrit, R., Boico, O., Castaigne, A. Anesthesiology (1989) [Pubmed]
  13. Human skin flora as a potential source of epidural abscess. Sato, S., Sakuragi, T., Dan, K. Anesthesiology (1996) [Pubmed]
  14. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 2): effect of epinephrine. Bernards, C.M., Shen, D.D., Sterling, E.S., Adkins, J.E., Risler, L., Phillips, B., Ummenhofer, W. Anesthesiology (2003) [Pubmed]
  15. Pharmacokinetics and efficacy of epidurally delivered sustained-release encapsulated morphine in dogs. Yaksh, T.L., Provencher, J.C., Rathbun, M.L., Kohn, F.R. Anesthesiology (1999) [Pubmed]
  16. Epidural anesthesia accelerates the recovery of postischemic bowel motility in the rat. Udassin, R., Eimerl, D., Schiffman, J., Haskel, Y. Anesthesiology (1994) [Pubmed]
  17. Radicular artery blood flow does not redistribute fentanyl from the epidural space to the spinal cord. Bernards, C.M., Sorkin, L.S. Anesthesiology (1994) [Pubmed]
  18. Epinephrine is metabolized by the spinal meninges of monkeys and pigs. Kern, C., Mautz, D.S., Bernards, C.M. Anesthesiology (1995) [Pubmed]
  19. Absorption of lidocaine following subarachnoid and epidural administration. Giasi, R.M., D'Agostino, E., Covino, B.G. Anesth. Analg. (1979) [Pubmed]
  20. Incidence of lower thoracic ligamentum flavum midline gaps. Lirk, P., Colvin, J., Steger, B., Colvin, H.P., Keller, C., Rieder, J., Kolbitsch, C., Moriggl, B. British journal of anaesthesia. (2005) [Pubmed]
  21. The dorsomedian connective tissue band in the lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases. Blomberg, R. Anesth. Analg. (1986) [Pubmed]
  22. Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain. Williams, K.N., Jackowski, A., Evans, P.J. Pain (1990) [Pubmed]
  23. Comparative absorption and distribution pharmacokinetics of intravenous and epidural sufentanil for major abdominal surgery. Taverne, R.H., Ionescu, T.I., Nuyten, S.T. Clinical pharmacokinetics. (1992) [Pubmed]
  24. Dangers from methylprednisolone acetate therapy by intraspinal injection. Nelson, D.A. Arch. Neurol. (1988) [Pubmed]
  25. Malignant extradural spinal tumors: MR imaging with Gd-DTPA. Sze, G., Krol, G., Zimmerman, R.D., Deck, M.D. Radiology. (1988) [Pubmed]
  26. Metrizamide epidurography in dogs. Kido, D.K., Schoene, W., Baker, R.A., Rumbaugh, C.L. Radiology. (1978) [Pubmed]
  27. Up-regulated expression of matrilysin and neutrophil collagenase in human herniated discs. Haro, H., Shinomiya, K., Murakami, S., Spengler, D.M. Journal of spinal disorders. (1999) [Pubmed]
  28. Thoracic epidural anesthesia via the lumbar approach in infants and children. Blanco, D., Llamazares, J., Rincón, R., Ortiz, M., Vidal, F. Anesthesiology (1996) [Pubmed]
  29. Effect of stimulus intensity and voluntary contraction on corticospinal potentials following transcranial magnetic stimulation. Kaneko, K., Kawai, S., Fuchigami, Y., Shiraishi, G., Ito, T. J. Neurol. Sci. (1996) [Pubmed]
  30. Disk fragment migration. Schellinger, D., Manz, H.J., Vidic, B., Patronas, N.J., Deveikis, J.P., Muraki, A.S., Abdullah, D.C. Radiology. (1990) [Pubmed]
  31. Influence of venous return on baroreflex control of heart rate during lumbar epidural anesthesia in humans. Baron, J.F., Decaux-Jacolot, A., Edouard, A., Berdeaux, A., Samii, K. Anesthesiology (1986) [Pubmed]
  32. Pain following thoracotomy. A randomised, double-blind comparison of lumbar versus thoracic epidural fentanyl. Coe, A., Sarginson, R., Smith, M.W., Donnelly, R.J., Russell, G.N. Anaesthesia. (1991) [Pubmed]
  33. Gastric emptying following caesarean section and the effect of epidural fentanyl. Geddes, S.M., Thorburn, J., Logan, R.W. Anaesthesia. (1991) [Pubmed]
  34. Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery. Dong, C.C., MacDonald, D.B., Janusz, M.T. Ann. Thorac. Surg. (2002) [Pubmed]
  35. Use of polylactide resorbable film as an adhesion barrier. Welch, W.C., Thomas, K.A., Cornwall, G.B., Gerszten, P.C., Toth, J.M., Nemoto, E.M., Turner, A.S. J. Neurosurg. (2002) [Pubmed]
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