Lateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block.

BACKGROUND AND OBJECTIVES: The use of the laterally directed cervical epidural catheter for the treatment of acute and chronic pain has not been previously described. We have used this technique in a series of 30 patients to produce unilateral upper extremity analgesia and sympathetic block. We present a case report of a patient treated with this technique and a description of the technique and results from the series. METHODS: We placed an epidural catheter at the C6-7 vertebral interspace and directed the needle bevel and catheter to the affected side in a woman with a history of complex regional pain syndrome of the right upper extremity. RESULTS: We were able to show a unilateral block with this technique by anatomic parameters (unilateral contrast dye spread), physiologic parameters (unilateral Horner's syndrome), and symptomatic parameters (unilateral, subjective neural block). Although 1 patient treated with this technique had bilateral effects, no patient has had a predominant block on the contralateral side and there have been no complications. CONCLUSIONS: This case report shows results typical of this series of 30 patients. In this series, the laterally directed cervical epidural catheter was an effective technique to produce continuous unilateral analgesia and sympathetic block. Key Words: Analgesia (epidural), Autonomic nerve block, Reflex sympathetic dystrophy, Postoperative pain.

Duke Scholars

Author Thomas Edward Buchheit Anesthesiology, Pain Management