Application of Epidural Catheter at Prone Jackknife Position
Atilla Tutak, Recai Kaya, Öznur Uludağ, Mevlüt Doğukan
Adıyaman Üniversitesi Tıp Fakültesi Eğitim Araştırma Hastanei
BACKGROUND: One of the most important factors in general or regional anesthesia applications is appropriate positioning of the patient. But sometimes this can not be achieved due to limitation of patient's clinical condition. CASE: A 17 years old female patient (weight: 45kg, and height: 162 cm) presented to hospital with 2nd-3rd degree burns at her buttock, thigh and back of the leg. Treatment was planned on alternate days for debridement of necrotic plaques and grafting. We decided to place an epidural catheter at jackknife position because she needed treatments for a long period and she had difficulty lying supine. Drugs and equipments for emergency situations were made ready. Then, 18 G tuohy epidural needle was inserted from L4-5 space with loss of pressure method. Procedure was successful at first attempt and an epidural catheter was placed. DISCUSSION: Epidural anesthesia can be used efficiently in appropriate patients who need acute and chronic pain management. Epidural techniques are also used frequently in surgical anesthesia, obstetric anesthesia, and postoperative pain management (1). Epidural catheter placement increases comfort of the patient during long term treatments. With epidural catheters blockage time may be increased, blockage level may be elevated and postoperative analgesia may be achieved (2).Lateral decubitus, sitting, and prone positions are standard positions for epidural anesthesia applications. But ideal position may not be reached in all patients and this makes the procedure more difficult. Prone jackknife position was chosen in our patient because sitting or lateral decubitus positions were impossible to achieve.
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