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Spaces, Epidural

Epidural spaces are the potential spaces located between the dura mater and the spinal canal or between the dura mater and the vertebral canal.
These spaces can be accessed for the administration of anesthetic or analgesic agents, known as epidural anesthesia or epidural analgesia, respectively.
Epidural spaces play a crucial role in pain managment and are an important consideration in various medical procedures.
Researchers can utilize PubCompare.ai to streamline their epidural research, locating the best protocols from literature, pre-prints, and patents, and making data-driven decisions to optimize their studies.

Most cited protocols related to «Spaces, Epidural»

1
Chronic ECoG Recording in Macaque Monkeys
All experimental and surgical procedures were performed in accordance with the experimental protocols (No. H24-2-203(4)) approved by the RIKEN ethics committee and the recommendations of the Weatherall report, "The use of non-human primates in research". Implantation surgery was performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. No animal was sacrificed in this study. Overall care was managed by the Division of Research Resource Center at RIKEN Brain Science Institute. The animal was housed in a large individual enclosure with other animals visible in the room, and maintained on a 12:12-h light:dark cycle. The animal was given food (PS-A; Oriental Yeast Co., Ltd., Tokyo, Japan) and water ad libitum, and also daily fruit/dry treats as a means of enrichment and novelty. The animal was occasionally provided toys in the cage. The in-house veterinary doctor checked the animal and updated daily feedings in order to maintain weight. We have attempted to offer as humane treatment of our subject as possible.
Neural and behavioral recordings were performed by employing a multi-dimensional recording technique [13 (link)]. Chronically implanted, customized multichannel ECoG electrode arrays (Unique Medical, Japan) were used for neural recording [13 (link)]. Electrodes were made of 3-mm diameter platinum discs that were dimpled at the center after being exposed to an insulating silicone sheet 0.8 mm in diameter. The array was implanted in the subdural space in 4 adult macaque monkeys（M1-M3 are Macaca fuscata and M4 is Macaca mulatta). One hundred and twenty-eight channel ECoG electrodes with an interelectrode distance of 5 mm were implanted in the left hemisphere, continuously covering over the frontal, parietal, temporal, and occipital lobes (Figure 1A and S1). Additionally the electrodes of Monkey M1 covered the medial frontal and parietal walls and the electrodes of Monkey M2 covered the medial frontal and occipital walls. Reference electrodes were made of rectangular platinum plates placed in the subdural space between the ECoG array and dura mater. Lastly, ground electrodes were placed in the epidural space (See 13 (link) for the detailed method). Parts of the dataset are shared in the public server Neurotycho.org (http://neurotycho.org/) [13 (link)].
Yanagawa T., Chao Z.C., Hasegawa N, & Fujii N. (2013). Large-Scale Information Flow in Conscious and Unconscious States: an ECoG Study in Monkeys. PLoS ONE, 8(11), e80845.
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Publication 2013
Adult Anesthesia Animals Asian Persons Brain Dura Mater Electrocorticography Ethics Committees Food Fruit Homo sapiens Japanese Monkeys Macaca Macaca mulatta Monkeys Nervousness Occipital Lobe Operative Surgical Procedures Ovum Implantation Pentobarbital Sodium Physicians Platinum Primates Silicones Spaces, Epidural Subdural Space Yeast, Dried
2
Temporary Spinal Cord Stimulator Implantation
The temporary implantation of the spinal cord stimulator was performed under fluoroscopic guidance with local anesthesia (Dong et al., 2017 ). The targeted spinal level of implantation was evaluated preoperatively according to the dermatomes of the HZ lesion. The patient was placed prone, and the paramedial approach was used to insert the Tuohy needle into the epidural space (Dong et al., 2017 ). The needle stylet was removed, and an eight-contact stimulation lead (model 3873; Medtronic, Minneapolis, MN, United States) was inserted through the Tuohy needle and advanced toward the targeted spinal segment under fluoroscopic imaging (Figures 1B,C). A test of the stimulation was required during implantation to ensure optimal coverage of the painful dermatomes. We only enrolled patients in the study who had only one electrode implanted. To avoid the potential migration of electrodes, patients were required to stay in bed for 48 h after surgery.
Zhou H., Han R., Chen L., Zhang Z., Zhang X., Wang J., Liu Z, & Huang D. (2022). Effect of Implantable Electrical Nerve Stimulation on Cortical Dynamics in Patients With Herpes Zoster–Related Pain: A Prospective Pilot Study. Frontiers in Bioengineering and Biotechnology, 10, 862353.
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Publication 2022
Fluoroscopy Local Anesthesia Needles Operative Surgical Procedures Ovum Implantation Pain Patients Spaces, Epidural Spinal Cord
3
Finite Element Modeling of Spinal Cord Stimulation
We generated a 3D FEM of SCS at the lower thoracic spinal levels. This FEM included representations of gray matter, white matter, cerebrospinal fluid (CSF), dura, epidural tissue, bone, intervertebral discs, electrode encapsulation layer, and bulk tissue. We defined the gray and white matter boundaries of the spinal cord model using cadaveric cross-sections at the T11 spinal cord level [25 (link)], [26 (link)]. At each spinal cord level, we included a dorsal root that was divided into five 0.25 mm diameter rootlets [27 (link)]–[29 (link)]. We separated the entry of each rootlet into the spinal cord by 3.28 mm in the rostrocaudal direction, resulting in a dorsal root entry zone of 13.1 mm [27 (link)]. Each rootlet individually ascended 46.5 mm rostrocaudally through the CSF and followed a curved trajectory before entering the spinal cord (Figure 1A) [26 (link)], [30 (link)]. We surrounded the spinal cord with a CSF domain that was enclosed by dura mater with a thickness of 0.3 mm [31 (link)]. The distance between the dorsal surface of the spinal cord and the dura was 3.2 mm [14 (link)]. Exterior to the dura, we placed an epidural tissue domain that included a percutaneous SCS lead with eight annular electrodes. Each electrode had a length of 3 mm and a diameter of 1.3 mm with an edge-to-edge spacing of 1 mm. We also included a 0.3 mm thick encapsulation layer domain surrounding the electrode array [32 (link)]. We placed the lead and encapsulation layer domain on the dorsal surface of the dura at the anatomical midline of the spinal cord. Around the epidural space, we stacked seven identical and anatomically-accurate T9 vertebrae with intervertebral discs to represent the vertebral column [33 (link)]–[35 ]. The center-to-center distance between each vertebrae was 22.2 mm, which resulted from an endplate thickness of 19.3 mm and an intervertebral disc thickness of 3.86 mm [33 (link)], [35 ]. Finally, we included a bulk tissue layer with dimensions representative of an average male body [36 (link)]–[38 ] (Figure 1A). We discretized our FEM into tetrahedral elements using 3matic (Materialise NV, Belgium), defining a region of interest (within 17.5 mm of the SCS lead) with higher node densities near the lead and resulted in a finalized mesh containing more than 51 million elements.
To calculate the voltage distributions generated during SCS, we imported our mesh into COMSOL (COMSOL Inc., USA). We initially defined electrical conductivities for each tissue type using data from the literature (Table 1) [12 (link)], [14 (link)], [32 (link)]. We then adjusted the electrical conductivity of the encapsulation layer until the FEM produced electrode impedances resembling average impedance values measured clinically (i.e. monopolar impedance of 370 Ω) [7 (link)]. We calculated the extracellular voltage distributions by assigning Dirichlet boundary conditions of a unit stimulus (i.e. 1 V) at the cathode and ground at the anode (i.e. 0 V). We modeled inactive contacts as equipotential with zero net current across their surface. We applied an insulating boundary condition to the outer boundaries of the FEM. We performed simulations for bipolar stimulation with a center-to-center spacing of 8 mm between the anode and cathode. We calculated electrostatic FEM solutions with an iterative equation solver using the conjugate gradient method (Figure 1B). The resulting voltages were interpolated and applied to the axon models presented in Step 2.
Zander H.J., Graham R.D., Anaya C.J, & Lempka S.F. (2020). Anatomical and technical factors affecting the neural response to epidural spinal cord stimulation. Journal of neural engineering, 17(3), 036019.
Publication 2020
Axon Bones Cerebrospinal Fluid Dietary Fiber Dura Mater Electric Conductivity Electrostatics Gray Matter Histocompatibility Testing Intervertebral Disc Males Root, Dorsal Spaces, Epidural Spinal Cord Tissues Vertebra Vertebral Column White Matter
4
6-OHDA Rat Model of Parkinson's Disease
Rats in the 6-OHDA + DCS group underwent two separate surgical procedures. First, they were implanted with spinal stimulation electrodes under anesthesia induced with 5% halothane, ketamine (100 mg/kg), xylazine (10 mg/kg) and atropine (0.05 ml). Postoperative weight was monitored daily. The implantation procedure was adapted from previous studies5 (link)36 (link). The electrodes were inserted in the epidural space under T2 (thoracic vertebra) and tied to it with surgical suture. This prevented electrode migration and facilitated stimulation over a long period. One week later, after recovery of initial weight, rats were anesthetized for a second surgery, with 5% halothane, followed by intramuscular injections of ketamine (100 mg/kg), xylazine(10 mg/kg) and atropine (0.05 ml). A total of 52.5 ug 6-OHDA hydrobromide (Sigma Company, USA - 3.5 mg/ml in 0.05% ascorbate saline) was injected bilaterally into the striatum, at 3 locations on each side, using a needle, driven by a syringe pump (Sage, Model 361, Firstenberg Machinery Co Inc., USA) via 10 uL Hamilton syringe, at 1 uL/min. The needle was left in situ for 5 minutes and withdrawn slowly, to prevent backtracking of the drug. Anteroposterior, mediolateral and dorsoventral coordinates for the injections were: +1.0, +/−3.0, −5.0; −0.1, +/−3.7, −5.0 and −1.2, +/−4.5, −5.037 (link) from bregma. Destruction of noradrenergic fibers and terminals was prevented by 1,3-Dimethyl-2-imidazolidinone (DMI, Sigma Company, 25 mg/kg), administered IP, 30 minutes prior to 6-OHDA treatment38 (link).
Rats belonging to the 6-OHDA lesion and sham control groups underwent only the surgical procedure required to perform the lesion; animals in the 6-OHDA lesion group received bilateral injections of 6-OHDA, while rats in the sham control group received only vehicle solution (0.05% ascorbate saline). Time course of the entire experiment is shown in Fig. 1a. The lesion procedures were performed by the same individuals throughout all the experiment and all groups were run in parallel. Extreme care was taken to consistently maintain the timing of the various methods and conditions during the lesion procedure.
Yadav A.P., Fuentes R., Zhang H., Vinholo T., Wang C.H., Freire M.A, & Nicolelis M.A. (2014). Chronic Spinal Cord Electrical Stimulation Protects Against 6-hydroxydopamine Lesions. Scientific Reports, 4, 3839.
Publication 2014
2-imidazolidinone Anesthesia Animals Atropine Halothane Intramuscular Injection Ketamine Needles Operative Surgical Procedures Ovum Implantation Pharmaceutical Preparations Rattus norvegicus Saline Solution Spaces, Epidural Striatum, Corpus Sutures Syringes Vertebrae, Thoracic Xylazine
5
Intrathecal Injection Technique in Neonatal Rats
Pups were anesthetized with isoflurane (3–5%) in oxygen and air. Percutaneous intrathecal injections were made at the low lumbar level (intervertebral space L4–5 or L5–L6) with a 30-gauge needle perpendicular to the skin. Injectate volumes of 0.5 or 1.0 mcl per gram bodyweight were delivered using a hand-driven micro injector (P3 and P10) or a 50 mcl Hamilton syringe (P21). As previously described in adult rats, intrathecal placement was suggested by a lateral tail flick as the needle entered the subarachnoid space33 (link) and confirmed by the distribution of 5% methylene blue in the injectate (Fisher Scientific, Fair Lawn, NJ). Within 2 h of injection animals were given intraperitoneal 100mg/kg pentobarbital, exsanguinated by cardiac puncture, and the spinal cord dissected. Intrathecal injections were defined by staining that was limited to the spinal cord and cerebrospinal fluid without pooling of dye in the epidural space or within paravertebral tissues. In most cases the injection site through the dura could be visualized but there was no obvious damage to underlying structures. The spread of dye was assessed by microscopic visualization and expressed as the number of vertebral segments above the injection level.
To assess intrathecal injectate distribution in vivo, P3 and P10 rats received intrathecal injections of 50% SAIVI™ Alexa Fluor® 680 in bovine serum albumin (Invitrogen, Eugene, OR) diluted in sterile saline. Injected volumes were 0.5, 1.0 or 1.5 mcl/g bodyweight. Rats were anesthetized with isoflurane anesthesia (1–2% in air/oxygen) and body temperature was maintained with a thermostatically controlled heat pad, and images were obtained at 30-min intervals for 2 h by the Xenogen®IVIS 100, in-vivo imaging system (Caliper Life Sciences, Hopkinton, MA).
Westin B.D., Walker S.M., Deumens R., Grafe M, & Yaksh T.L. (2010). Validation of a Preclinical Spinal Safety Model: Effects of Intrathecal Morphine in the Neonatal Rat. Anesthesiology, 113(1), 183-199.
Publication 2010
Adult Anesthesia Animals Body Temperature Body Weight Cerebrospinal Fluid Dura Mater Heart Intrathecal Injection Isoflurane Lumbar Region Methylene Blue Microscopy Needles Oxygen Pentobarbital Punctures Rattus Saline Solution Serum Albumin, Bovine Skin Spaces, Epidural Spinal Cord Sterility, Reproductive Subarachnoid Space Syringes Tail Tissues Vertebra

Most recents protocols related to «Spaces, Epidural»

1
Epidural Injection Distribution Pattern Evaluation
Prior to administration, the data regarding the demographic characteristics, such as, pain duration, pain severity, and involved nerve root were extracted. Two radiologists retrospectively analyzed and recorded the IDP on postintervention CT scanning images. The injection spread patterns in the cross-sectional CT images included the following: Zone I: extra-foraminal; Zone II: the foraminal spaces; Zone III: intra-foraminal (Figure 3).

The injection distribution area in the cross section of CT image: Line A is from anterolateral vertebral body to the lateral margin of the facet. Line B is from posterior-lateral vertebral body to the interior margin of the facet. Line C is the axial centerline of the epidural space. Zone I The out space of line A is extra-foraminal; Zone II: Between line A and B is the foraminal spaces; Zone III: Between line B and C is intra-foraminal/epidural spaces.

An investigator blinded to the patient assignments/treatments performed patient follow-ups, and recorded pain scores, particularly, NRS during hospital visits at 2 hours, 1 week, and 4 weeks after injection.
Safety was assessed as follows: ① Bleeding situation: Prior to drug injection, we recorded whether there was blood upon withdrawal, and verified the presence or absence of hematoma via CT scan. ② Other adverse reactions, including, puncture point pain, shortness of breath, paresthesias, motor deficit, hematoma, dizziness, headache, vomiting, general spinal anesthesia, and so on.
Ma L., Wang Y., Yao M., Huang B., Deng J, & Wen H. (2023). Evaluating the Extent of Ultrasound-Guided Cervical Selective Nerve Root Block in the Lower Cervical Spine: Evidence Based on Computed Tomography Images. Journal of Pain Research, 16, 669-676.
Publication 2023
BLOOD Dyspnea General Anesthesia Headache Hematoma Nervousness Pain Paresthesia Patients Pharmaceutical Preparations Plant Roots Punctures Radiologist Safety Severity, Pain Spaces, Epidural Vertebral Body X-Ray Computed Tomography
2
Anesthetic Induction and Epidural Analgesia

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Publication 2023
Anesthesia Bupivacaine Catheters Dipyrone Epidural Anesthesia Intravenous Infusion Management, Pain Needles Normal Saline One-Lung Ventilation Operative Surgical Procedures Patients Pirinitramide Propofol Rocuronium Spaces, Epidural Sufentanil
3
Thoracic Epidural Analgesia Protocol
In a lateral decubitus position, the interlaminar space between the 6th and 7th thoracic vertebrae was identified using ultrasound by counting ribs and TPs of thoracic vertebrae downward from the first rib. The patient underwent skin disinfection and received a block, and an 18G Tuohy needle (Perifix® Soft Tip 700 Filter Set; B. Braun, Melsungen, Germany) was inserted via a paramedian approach. Using the loss-of-resistance approach, the epidural space was detected, and a multi-orifice catheter was placed around 3 cm beyond the needle’s tip. After measuring the location of the catheter tip using fluoroscopy with a contrast agent, a test dose of 3 mL 2% lidocaine with 15 µg epinephrine was administered to ensure that the catheter was not in the subarachnoid space or epidural vein. A loading dose of 6 mL 0.375% ropivacaine was administered 30 minutes before the end of surgery. A PCA system was used to deliver 0.2% ropivacaine (Accumate 1200; Woo Young Medical, Seoul, Korea; 250 mL 0.2% ropivacaine, background infusion rate 3 mL/hour (h), bolus volume 3 mL, lock-out interval 20 minutes) for 2 postoperative days.
Hong J.M., Kim E., Jeon S., Lee D., Baik J., Cho A.R., Cho J.S, & Ahn H.Y. (2023). A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery. Saudi Medical Journal, 44(2), 155-163.
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Publication 2023
Catheters Contrast Media Disinfection Epinephrine Fluoroscopy Lidocaine Needles Operative Surgical Procedures Patients Ropivacaine Skin Spaces, Epidural Strains Subarachnoid Space Ultrasonography Veins Vertebrae, Thoracic
4
Continuous Epidural vs. ESP Block for VATS
This prospective, randomized, double-blind study was approved by Pusan National University Hospital’s Institutional Review Board (No. H-1807-029-069) and was registered with cris.nih.go.kr (registration number: KCT0003836; date of registration: August 31, 2018). This study was carried out in accordance with the principles of the Helsinki Declaration. An informed consent was obtained from 60 patients with the American Society of Anesthesiologists physical status classification I-II aged 18 to 85 years and scheduled for lung resection using VATS from October 2018 to May 2019 in Pusan National University Hospital, Busan, Korea. Patients who met any of the following criteria were excluded: inability to understand or give informed consent; chronic use of opioids or steroids; the presence of heart, liver, or kidney function abnormalities; infection at the site of the analgesic procedure; abnormal coagulation profile; or a body mass index higher than 30 kg/m2 (link)
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Two groups of patients having VATS were randomly assigned: Group E (n=30) got continuous epidural analgesia, while Group ES (n=30) received continuous ESP block. They were allocated to each group using block randomization tables generated using Randomization.com (http://www.randomization.com). A single anesthesiologist performed all analgesic procedures before inducing general anesthesia in the operating theatre. Ultrasound was used to identify vertebral levels in both groups and guide needle advance and catheter placement in the ESP block group. Fluoroscopy was applied to check the catheter tip position in both groups and confirm the epidural space in the epidural group. Ultrasound and fluoroscopy were used with all patients, so patients could not tell which procedure was performed. Researchers who did not attend the analgesic procedures recorded the postoperative pain score and complications. In addition, patient-controlled analgesia (PCA) pump settings and drugs were also recorded using an electronic data collection tool.
Hong J.M., Kim E., Jeon S., Lee D., Baik J., Cho A.R., Cho J.S, & Ahn H.Y. (2023). A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery. Saudi Medical Journal, 44(2), 155-163.
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Publication 2023
Analgesics Anesthesiologist Catheter Obstruction Catheters Congenital Abnormality Epidural Anesthesia Ethics Committees, Research Fluoroscopy General Anesthesia Heart Index, Body Mass Infection Kidney Liver Lung Needles Opioids Pain, Postoperative Patient-Controlled Analgesia Patients Pharmaceutical Preparations Physical Examination Spaces, Epidural Steroids Tests, Blood Coagulation Thoracic Surgery, Video-Assisted Ultrasonics Vertebra
5
CT-Guided Ozone Injection for Spinal Cysts
All CT-guided interventions were performed at our out-patient clinic by a single interventional radiologist with a 25 years’ experience in spine disease and treatments.
Patient was placed in the prone position, with a support under the belly in order to prevent excessive back lordosis. Low-dose CT scan of the lumbar region was performed.
Following the conclusion of procedural planning, sterile disinfection of the lumbar region was obtained. Local anaesthesia was routinely not performed.
The LFSC was accessed with a 22G Chiba needle, via a transforaminal approach for foraminal cysts, and ipsilateral or contralateral translaminar approach for medially placed lesions.
Additional low dose CT scans were performed to guide needle positioning until the cyst was entered; aspiration of the cyst was then performed followed by injection of 1-2 mL of gas mixture (2% O3, 98% O2). Final CT scan was then performed to confirm cyst rupture and gas leakage in the epidural space and facet joint (Figure 1 and 2).
When a transforaminal access was used, additional administration of 8 mL of ozone gas mixture and 2 mL of corticosteroid/local anaesthetic was performed after withdrawal of the needle into the foraminal space.
Patients were then discharged after a brief observation interval of 2 hours and referred for follow-up assessment.
Masala S., Lacchè A., Salimei F., Ursone A., Pipitone V., Masino F., D’Arma G.M, & Guglielmi G. (2023). CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts. Acta Bio Medica : Atenei Parmensis, 94(1), e2023025.
Publication 2023
Adrenal Cortex Hormones Cyst Disinfection Facet Joint Local Anesthesia Lordosis Lumbar Region Needles Outpatients Ozone Patients Radiologist Spaces, Epidural Spinal Diseases Sterility, Reproductive X-Ray Computed Tomography

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More about "Spaces, Epidural"

The epidural space is a critical anatomical region located between the dura mater and the vertebral canal or spinal canal.
This potential space can be accessed for the administration of anesthetic or analgesic agents, known as epidural anesthesia or epidural analgesia, respectively.
These procedures play a crucial role in pain management and are an important consideration in various medical interventions.
Researchers studying the epidural space can utilize powerful tools like PubCompare.ai to streamline their investigations.
This platform helps locate the best protocols from literature, pre-prints, and patents, enabling data-driven decisions to optimize epidural research studies.
The epidural space is closely related to other key medical concepts, such as the high-speed drill, which can be used to access the epidural region during certain procedures.
The Specify 5–6-5 lead and Infinion devices are also relevant, as they may be used in epidural electrode implantation for neuromodulation therapies.
The S88 stimulator and BAT7001H are examples of equipment that can be utilized during epidural interventions.
Additionally, the contrast agent Omnipaque may be employed to visualize the epidural space, while the IntelliVue Monitoring system can be used to track patient vitals during epidural procedures.
Medications like Rimadyl and DMSO may also play a role in epidural pain management and recovery.
Finally, the 2-French Fogarty Catheter is a tool that can be utilized for epidural access and intervention.
By incorporating these related terms and concepts, researchers can gain a more comprehensive understanding of the epidural space and how it intersects with various medical technologies and therapies.
This knowledge can inform the design of more effective and efficient epidural research protocols.