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Intrathecal position of microcatheters
BRITISH JOURNAL OF ANAESTHESIA
612 position revealed an unintentional sacral direction of the spinal catheter. Van Gessel, Forster and Gamulin [4] found that 7 % of 20-gauge spinal catheters lay in a caudal direction and no correlation was found between the final sensory level achieved and the position of the catheter tip. The reason for this may have been that this study was performed with patients in the lateral decubitus position. Therefore, if the authors could correlate spread of local anaesthesia and the position of the spinal catheter, this may be of clinical importance. _ TT _ P. H. BIBOULET X. CAPDEVILA J. DESCHODT
1. 2. 3.
T. H. STANDL H. BECK
University Hospital Eppendorf Hamburg, Germany 1. Standl T, Back H. Influence of the intrathecal position of microcatheters on onset of analgesia and dose of plain 0.5 % bupivacaine in continuous spinal anaesthesia. Regional Anesthesia 1994; in press. 2. Van Gessel EF, Forster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheters go? Anesthesia and Analgesia 1993; 76: 1004-1007.
ERRATUM In the Editorial published in British Journal of Anaesthesia 1994; 72: 3-4, two errors have been noted: In the fourth paragraph of the first column, the sentence "Because of the different times that oxygen spends in various organs" should read "Because of the different times that blood spends in various organs". In the sixth paragraph, line 4 should read "Over the ensuing 2 min, an additional 0.6 litre would be added".
Downloaded from http://bja.oxfordjournals.org/ at Queen's University on March 8, 2015
4.
University of Montpellier Montpellier, France Standl T, Beck H. Radiological examination of the intrathecal position of microcatheters in continuous spinal anaesthesia. British Journal of Anaesthesia 1993; 71: 803-806. Riger ML, Drasner K. Distribution of catheter-injected local anaesthetic in a model of the subarachnoid space. Anesthesiology 1991; 75: 684-692. Biboulet PH, Deschodt J, Aubas P, Vacher E, Chauvet PH, d'Athis F. Continuous spinal anesthesia: does low-dose plain or hyperbaric bupivacaine allow the performance of hip surgery in the elderly } Regional Anesthesia 1993; 18: 170-175. Van Gessel EF, Forster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheters go? Anesthesia and Analgesia 1993; 76: 1004-1007.
Sir,—We agree that the intrathecal position of a spinal microcatheter is important and it may affect the outcome of continuous spinal anaesthesia. We have examined therefore the influence of the intrathecal position of 28-gauge spinal catheters, on the time of onset of analgesia and on the dose requirements of local anaesthetic in another study which is now in press [1]. In contrast with large-bore catheters [2] which allow for higher injection speed, we found that intrathecal catheter position had a significant influence on the outcome of continuous spinal anaesthesia. However, our original study was designed to evaluate the effect of position of the patient during lumbar puncture and depth of intrathecal insertion of the catheter on the intrathecal position of a microcatheter. Also, the aim was to evaluate the performance of spinal microcatheters to avoid caudally directed catheter positions which may be associated with maldistribution of local anaesthetic.
612 position revealed an unintentional sacral direction of the spinal catheter. Van Gessel, Forster and Gamulin [4] found that 7 % of 20-gauge spinal catheters lay in a caudal direction and no correlation was found between the final sensory level achieved and the position of the catheter tip. The reason for this may have been that this study was performed with patients in the lateral decubitus position. Therefore, if the authors could correlate spread of local anaesthesia and the position of the spinal catheter, this may be of clinical importance. _ TT _ P. H. BIBOULET X. CAPDEVILA J. DESCHODT
1. 2. 3.
T. H. STANDL H. BECK
University Hospital Eppendorf Hamburg, Germany 1. Standl T, Back H. Influence of the intrathecal position of microcatheters on onset of analgesia and dose of plain 0.5 % bupivacaine in continuous spinal anaesthesia. Regional Anesthesia 1994; in press. 2. Van Gessel EF, Forster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheters go? Anesthesia and Analgesia 1993; 76: 1004-1007.
ERRATUM In the Editorial published in British Journal of Anaesthesia 1994; 72: 3-4, two errors have been noted: In the fourth paragraph of the first column, the sentence "Because of the different times that oxygen spends in various organs" should read "Because of the different times that blood spends in various organs". In the sixth paragraph, line 4 should read "Over the ensuing 2 min, an additional 0.6 litre would be added".
Downloaded from http://bja.oxfordjournals.org/ at Queen's University on March 8, 2015
4.
University of Montpellier Montpellier, France Standl T, Beck H. Radiological examination of the intrathecal position of microcatheters in continuous spinal anaesthesia. British Journal of Anaesthesia 1993; 71: 803-806. Riger ML, Drasner K. Distribution of catheter-injected local anaesthetic in a model of the subarachnoid space. Anesthesiology 1991; 75: 684-692. Biboulet PH, Deschodt J, Aubas P, Vacher E, Chauvet PH, d'Athis F. Continuous spinal anesthesia: does low-dose plain or hyperbaric bupivacaine allow the performance of hip surgery in the elderly } Regional Anesthesia 1993; 18: 170-175. Van Gessel EF, Forster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheters go? Anesthesia and Analgesia 1993; 76: 1004-1007.
Sir,—We agree that the intrathecal position of a spinal microcatheter is important and it may affect the outcome of continuous spinal anaesthesia. We have examined therefore the influence of the intrathecal position of 28-gauge spinal catheters, on the time of onset of analgesia and on the dose requirements of local anaesthetic in another study which is now in press [1]. In contrast with large-bore catheters [2] which allow for higher injection speed, we found that intrathecal catheter position had a significant influence on the outcome of continuous spinal anaesthesia. However, our original study was designed to evaluate the effect of position of the patient during lumbar puncture and depth of intrathecal insertion of the catheter on the intrathecal position of a microcatheter. Also, the aim was to evaluate the performance of spinal microcatheters to avoid caudally directed catheter positions which may be associated with maldistribution of local anaesthetic.