Comparison of two lumbar epidural catheter

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T11, n=2. T11/T12,n=1. T12, n=1. T12/T13, n=2. L3/L4, n=2. L4, n=2. L5, n=2. Number of vertebral segments 2.92±0.53 (2-3.5) 2.92±0.67 (1.5-3.5). Group CauL.
Comparison of two lumbar epidural catheter indwelling techniques in dogs Zhang Di, Nagahama Shotaro, Fujita Naoki, Kamata Masatoshi, Kakishima Kei, Nishimura Ryohei Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo

Introduction 

Caudal lumbar epidural anesthesia technique (L7/S1)  



Simplicity, Safety, Effectiveness Limited to surgeries caudal to the umbilicus in dogs

Cranial lumbar epidural anesthesia technique (L1/L2, or L2/L3) Provides potent analgesia in thoracic and upper abdominal surgeries in humans --------------------------------------------- Uncommon in dogs  No obvious landmarks  Intervertebral space is physiologically narrow 

Purpose 

To compare the safety and feasibility of cranial and caudal lumbar epidural catheter indwelling techniques in dogs

Materials and Methods 

Animals 

Thirteen male beagles   



Anesthesia protocol 



 

Cranial lumbar vertebra group (group CraL, n=6) Caudal lumbar vertebra group (group CauL, n=6) One residual dog for a general anesthesia control

General anesthesia: isoflurane (induction and maintenance)

Epidural catheterization Euthanasia (deep anesthesia + KCL) Epidurography

Epidural catheterization 

18G Tuohy needle, 20G epidural catheter 



  

Group CraL: between L2 and L3 Group CauL: between L7 and S1

Epidural space confirmation-“loss of resistance” technique with saline Epidural catheter was advanced cephalad 10cm. Epidural injection of saline (0.2ml/kg) in single bolus.

a needle puncture

b catheter fixation

Evaluation method 

Objective indexes 

  

Success rate of catheter indwelling Time consumed for catheter indwelling process Catheter position inside of the epidural space Histological examination  



Macroscopic observations (tissue color, bleeding, swelling) Microscopic observations

Subjective index-to evaluate the handling difficult degree of epidural catheter indwelling process 

5 grades: Difficult; Relatively difficult; Moderate; Relatively easy; Easy

Results  

In all treated dogs (n=12), epidural catheters were inserted into the epidural space successfully. Time consumed Time (sec)

Group CraL (n=6)

Group CauL (n=6)

Needle introduction 2nd introduction

90.0±39.8 3/6

74.3±16.9 1/6

Catheter insertion

44.3±10.1

57.3±18.3

Saline injection

91.7±26.5

97. 7±23.7

226.0±57.8

229.3±23.3

The whole process of epidural catheter indwelling

Catheter position and tip location Tail →

← Head

A

Group CraL

← Head

B

Tail →

Group CauL

T1 0T /T1 10/ 1T 1 1 T1 T1 1 1T /T1 T11 11/ 2T 1 T T1 12 2 2T /T1 T1 12/ 2 3T T1 13 T1 3 3 T T1 /L1 3 13/ L1 L1 L1 /LL L1 21/ L L2 2 L2 /LL L2 32/ L L3 3 L3 /LL L3 43/ L L4 4 L4 /LL L4 54 /L L5 5 L5 /LL L5 65 /L 6 L L6 6 /L L6 L76 /L 7 L L7 7 /S L7 L17 /S 1 S 1 S 1

Experiment dogs (n=12) Experiment dogs (n=12)

Group CauL

Group CraL

Parts of caudal thoracic and lumbar vertebrae

Group CraL, n=6

Group CauL, n=6

Parts of caudal thoracic and lumbar vertebrae

Predetermined epidural insertion site Actual punctured site

Catheter tip location Number of vertebral segments

L2/L3

L7/S1

L2/L3, n=1 L1/L2, n=5

L7/S1, n=3 L6/L7, n=3

T11, n=2 T11/T12,n=1 T12, n=1 T12/T13, n=2

L3/L4, n=2 L4, n=2 L5, n=2

2.92±0.53 (2-3.5)

2.92±0.67 (1.5-3.5)

Macroscopic observation 

Subcutaneous bleeding  

Group CraL: 3/6 Group CauL: 0/6

a



b

Tissue injuries (color change, bleeding, or swelling) of spinal cord were not detected in a control dog and in all treated dogs. d

c

Microscopic examination H.E.×40

H.E.×40

B-1

H.E ×200

B-2

A

B

 No significant

histopathological changes were detected in a control dog and in all treated dogs.

H.E ×200 B-3

H.E ×200

Subjective evaluation Group CraL Group CauL Difficult

0

0

Relatively difficult

0

0

Moderate

1

0

Relatively easy

4

1

Easy

1

5

Total

n=6

n=6

Discussion 

There were no significant tissue injuries of spinal cord for epidural catheter indwelling process in either group. 



Cranial lumbar epidural catheter indwelling technique—relatively safe

There were no differences in time consumed for procedures of epidural needle puncture and catheter insertion between groups. 

Cranial lumbar epidural catheter indwelling technique—not technically difficult

Conclusion 

These results may suggest that epidural catheter indwelling technique in cranial lumbar vertebral segments is safe and feasible as well as in caudal lumbar vertebral segments at least in medium-sized dogs.

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