• Masataka Yokoyama, Motohiko Hanazaki, Hiromi Fujii, Satoshi Mizobuchi, Hideki Nakatsuka, Toru Takahashi, Masaki Matsumi, Mamoru Takeuchi, and Kiyoshi Morita.
• Department of Anesthesiology and Resuscitology, Okayama Medical School, Okayama City, Okayama, Japan. masayoko@cc.okayama-u.ac.jp
• Anesthesiology. 2004 Jun 1;100(6):1504-10.

BackgroundIf the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread.MethodsAn epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic area was determined by pinprick after a 5-ml injection of 1.5% lidocaine, and epidurography was performed after a 5-ml injection of 240 mg I/ml iotrolan. Patients were assigned to three groups according to catheter tip position (group C: C-T4; group T: T5-T10; group L: T11-L), and patterns of spread were compared. In 16 of 90 subjects, radiographic and analgesic spread was further investigated after an additional 5-ml injection of iotrolan and lidocaine.ResultsThe total radiographic spread correlated well with analgesic spread (right side: Y = 0.84 X + 0.16, r = 0.92, P < 0.01; left side: Y = 0.78 X + 0.45, r = 0.91, P < 0.01). The mean radiographic spread in the cephalad and caudal directions from the catheter tip also correlated well with mean analgesic spread (r = 0.97, P < 0.01, each direction). The mean distance between the predicted catheter tip and radiographically determined positions was 1.0 +/- 0.8 segments: the value in group T was significantly larger than that in groups C (P < 0.05) and L (P < 0.01). Although the correlation of radiographic spread with age was statistically significantly (r = 0.39, P < 0.01), great individual variation in spreading pattern was seen. In 16 subjects, mean radiographic spread correlated well with analgesic spread after 5- and 10-ml injections of iotrolan and lidocaine.ConclusionsEpidurography is useful to indicate epidural catheter position and can help to predict the exact dermatomal distribution of analgesic block.

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