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BJA Advance Access published online on December 24, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei061
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Accepted November 11, 2004

Case Report

Epidural analgesia after spinal surgery via intervertebral foramen

P. J. A. Sice 1*, D. Chan 2, and P. A. MacIntyre 1

1 Department of Anaesthesia, Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter, UK
2 Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Foundation Trust, Exeter, UK

* To whom correspondence should be addressed.
P. J. A. Sice, E-mail: paulsice{at}aol.com


  Abstract

Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml-1 provided excellent analgesia. The technique was associated with no postoperative complications.

Keywords: anaesthetic techniques, epidural; analgesia; surgery, spinal.
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