Experience of lumbar epidural insertion in 573 anesthetized patients

Performing regional blockade on anesthetized patients may increase the risk of postoperative neurologic complications, because these patients cannot respond to painful stimuli. In orthopedic patients, especially those with leg fracture, it is sometimes difficult to find a suitable position for epidural catheterization because of pain. This study evaluates the frequency of neurologic complications after lumbar epidural catheter placement in anesthetized adult patients undergoing orthopedic surgery. Among 581 patients, there were 8 failed epidural catheter insertion: the catheter could not be inserted in 4 patients including one dural puncture, and the position of the epidural catheter was judged as inappropriate in 4 patients postoperatively. In the remaining 573 patients, the catheter was inserted uneventfully under general anesthesia, and they received continuous local anesthetic infusion for postoperative analgesia. No neurologic complication related to epidural catheter was observed in these patients. This observation suggests that epidural puncture under general anesthesia may be acceptable in some conditions, for example obtaining appropriate consent, difficulty in positioning when awake, proper monitoring and vigilance, etc.