Original article| Volume 5, ISSUE 1, P19-31, January 1996

Download started.


Why obstetric epidurals fail: a study of epidurograms

      This paper is only available as a PDF. To read, Please Download here.


      In a study of the factors involved in the occasional failure of continuous obstetric epidural blockade, contrast injections through epidural catheters and radiographic screening were undertaken in 35 postpartum patients. The two major causes of inadequate block were found to be transforaminal escape of the catheter tip, and persistent unilateral block associated with an obstructive barrier in the epidural space. Recommendations for overcoming these problems are discussed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tanaka K
        • Watanabe R
        • Harada T
        • Dan K
        Extensive application of epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique.
        Reg Anesth. 1993; 18: 34-38
        • Ducrow M
        The occurrence of unblocked segments during continuous lumbar epidural analgesia for relief of pain in labour.
        Br J Anaesth. 1971; 43: 1172-1173
        • Hehre F.W
        • Sayig J.M
        • Lowman R.M
        Etiologic aspects of failure of continuous lumbar peridural anesthesia.
        Anesth and Analg. 1960; 39: 511-517
        • Collier C.B
        • Gatt S.P
        A new epidural catheter. Closer eyes for safety?.
        Anaesthesia. 1993; 48: 803-806
        • Collier C.B
        • Gatt S.P
        • Lockley S.M
        A continuous subdural block.
        Br J Anaesth. 1993; 70: 462-465
        • Michael S
        • Richmond M.N
        • Birks R.J.S
        A comparison between open-end (single-hole) and closed-end (three lateral holes) epidural catheters.
        Anaesthesia. 1989; 44: 578-580
        • Blomberg R
        The dorsomedian connective tissue band in the lumbar epidural space of humans. An anatomical study using epiduroscopy in autopsy cases.
        Anesth Analg. 1986; 65: 747-752
        • Savolaine E.R
        • Pandya J.B
        • Greenblatt S.H
        • Conover S.R
        Anatomy of the human lumbar epidural space: new insights using CT-epidurography.
        Anesthesiology. 1988; 68: 217-220
        • Hogan Q.H
        • Lynch K
        • Lacitis I
        Histologic features of epidural soft tissue and its relation to the dura and canal wall.
        Reg Anesth. 1993; 18S: 54
        • Nunn G
        • MacKinnon R.P.G
        Two unilateral epidural blocks.
        Anaesthesia. 1986; 41: 439-440
        • Collier C.B
        • Gatt S.P
        Epidural catheters for obstetrics. Terminal hole or lateral eyes?.
        Reg Anesth. 1994; 19: 378-385
        • Iklé A
        L'anésthesie péridurale continue en obstetrique. Technique speciale et experiences personelles.
        Rev Franc Gynec D'Obstet. 1952; 47: 185-197
        • Sanchez A
        • Acuna L
        • Rocha F
        An analysis of the radiological visualization of the catheters placed in the epidural space.
        Br J Anaesth. 1967; 39: 485-489
        • Bridenbaugh L.D
        • Moore D.C
        • Bagdi P
        • Bridenbaugh P.O
        The position of plastic tubing in continuous-block techniques: an X-ray study of 552 patients.
        Anesthesiology. 1968; 29: 1047-1049
        • Moir D.D
        • Willocks J
        Epidural analgesia in British obstetrics.
        Br J Anaesth. 1968; 40: 129-138
        • Harrison G.R
        • Clowes N.W.B
        The depth of the lumbar epidural space from the skin.
        Anaesthesia. 1985; 40: 685-687
        • Watts R.W
        The influence of obesity on the relationship between body mass index and the distance of the epidural space from the skin.
        Anaesth Intensive Care. 1993; 21: 309-310
        • Doughty A
        A precise method of cannulating the lumbar epidural space.
        Anaesthesia. 1974; 29: 63-65
        • Blomberg R.G
        Technical advantages of the paramedian approach for lumbar epidural puncture and catheter introduction. A study using epiduroscopy in autopsy subjects.
        Anaesthesia. 1988; 43: 837-843
        • Carrie L.E.S
        The paramedian approach to the epidural space.
        Anaesthesia. 1977; 32: 670-671
        • Bishton I.M
        • Martin P.H
        • Vernon J.M
        • Liu W.H.D
        Factors influencing epidural catheter migration.
        Anaesthesia. 1992; 47: 610-612
        • Usubiaga J.E
        • Reis A.dos
        • Usubiaga L.E
        Epidural misplacement of catheters and mechanisms of unilateral blockade.
        Anesthesiology. 1970; 32: 158-161
        • Hatten H.P
        Lumbar epidurography with metrizamide.
        Radiology. 1980; 137: 129-136
        • Hogan Q.H
        Lumbar epidural anatomy. A new look by cryomicrotome section.
        Anesthesiology. 1991; 75: 767-775
        • McCormick C.C
        Radiology in low back pain and sciatica. An analysis of the relative efficacy of spinal venography, discography and epidurography in patients with a negative or equivocal myelogram.
        Clin Radiol. 1978; 29: 393-406
        • Savolaine E.R
        CT-epidurography and the anatomy of the human lumbar epidural space.
        Anesthesiology. 1988; 69: 797-798
        • Gaynor A
        The lumbar epidural region: anatomy and approach.
        in: Reynolds F Epidural and spinal blockade in obstetrics. Balliere Tindall, London1990: 1-18
        • Schachner S.M
        • Abram S.E
        Use of two epidural catheters to provide analgesia of unblocked segments in a patient with lumbar disc disease.
        Anesthesiology. 1982; 56: 150-151
        • Moran D.H
        • Johnson M.D
        Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis.
        Anesth Analg. 1990; 70: 445-447
        • Pascoe H.F
        • Jennings G.S
        • Marx G.F
        Successful spinal anesthesia after inadequate epidural block in a parturient with prior surgical correction of scoliosis.
        Reg Anesth. 1993; 18: 191-192
        • Magides A.D
        • Richmond M.N
        Lumbar epidurography in multi-orifice and single orifice catheters.
        Reg Anesth. 1992; 17: 3S-180
        • Boezaart A.P
        • Levendig B.J
        Epidural air-filled bubbles and unblocked segments.
        Can J Anaesth. 1989; 36: 603-604
        • Dalens B
        • Bazin J
        • Haberer J
        Epidural bubbles as a cause of incomplete analgesia during epidural anesthesia.
        Anesth Analg. 1987; 66: 679-683
        • Aviles J
        • Barbaro N.M
        • Drasner K
        Pharmacology of descending hyperalgesia: Evidence for involvement of spinal cord kappa and alpha-adrenergic receptors.
        Anesthesiology. 1993; 79 (suppl): A906
        • Golomb E
        • Langerman L
        • Benita S
        Discrepancy between the development of tolerance to bupivacaine in extradural and spinal anaesthesia in rabbits.
        Br J Anaesth. 1993; 71: 450-452
        • Shanks C.A
        Four cases of unilateral epidural analgesia.
        Br J Anaesth. 1968; 40: 999-1002
        • Bromage P.R
        Epidural analgesia.
        in: WB Saunders, Philadelphia1978: 130-131