From the Guidelines
D12 compression by epidural block involves injecting local anesthetic and/or steroids into the epidural space at the D12 (T12) vertebral level to relieve pain from vertebral compression, with the most effective approach being a thoracic epidural analgesia using a bolus of 5 ml ropivacaine 2.5 mg.ml-1 solution followed by a 5 ml.h-1 infusion of the same solution, as supported by Zejun et al. 1. The procedure begins with patient positioning in either lateral decubitus or prone position.
- After sterilizing the injection site around the D12 level, the skin and subcutaneous tissues are anesthetized with 1-2% lidocaine.
- Using fluoroscopic guidance, a Tuohy needle (typically 18G) is inserted through the paramedian approach at the D12-L1 interspace.
- The needle is advanced until it reaches the epidural space, confirmed by loss of resistance technique using either air or saline.
- Once proper placement is verified, a test dose of 3ml lidocaine with epinephrine (1:200,000) is administered to rule out intravascular or intrathecal injection.
- If no adverse reactions occur, the therapeutic medication (typically 5-10ml of 0.25-0.5% bupivacaine with 40-80mg methylprednisolone) is slowly injected. The choice of medication and dosage is crucial, with thoracic epidural analgesia providing superiority in pain control at rest and mobilization, as well as reduced incidence of nausea and vomiting and shorter duration of postoperative ileus, as demonstrated by Zejun et al. 1.
- The needle is then removed, and the injection site is cleaned and bandaged.
- Patients are monitored for 30-60 minutes post-procedure for any adverse reactions. This technique works by delivering anti-inflammatory and analgesic medications directly to the affected nerve roots, reducing inflammation and interrupting pain signals from the compressed D12 vertebra to the brain, with thoracic epidural analgesia being a more effective approach compared to paravertebral block, as shown by Yeap et al. 1 and Huang et al. 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Procedure for D12 Compression by Inj. Epidural Block
The procedure for D12 compression by injection of epidural block involves several steps:
- Preparation of the patient, including positioning and sterilization of the skin 2
- Insertion of the epidural needle into the epidural space, typically at the level of the desired compression (in this case, D12) 3, 4
- Administration of a local anesthetic, such as bupivacaine or ropivacaine, into the epidural space to produce analgesia and compression of the spinal cord 3, 4, 5
- Monitoring of the patient's vital signs and neurological function during and after the procedure 3, 2
- Adjustment of the dose and volume of the local anesthetic as needed to achieve the desired level of compression and analgesia 4, 5
Key Considerations
Some key considerations when performing a D12 compression by injection of epidural block include:
- The choice of local anesthetic and dose, as different agents and concentrations can affect the level and duration of compression and analgesia 3, 4, 5
- The potential for complications, such as nerve damage or respiratory depression, and the need for close monitoring and emergency equipment 2, 6
- The importance of accurate placement of the epidural needle and administration of the local anesthetic to ensure effective compression and minimize risks 3, 4
Management of Epidural Block
The management of epidural block for D12 compression involves:
- Regular assessment of the patient's pain and neurological function 2, 4
- Adjustment of the epidural infusion or bolus doses as needed to maintain adequate analgesia and compression 4, 5
- Monitoring for potential complications, such as motor weakness or respiratory depression, and taking prompt action if they occur 2, 6