The fiberscopic findings of the epidural space in pregnant women.

Abstract

The spread of epidural analgesia is facilitated by pregnancy. Changes in the epidural structure during pregnancy may affect the spread of analgesia in pregnant women. To investigate the changes in the epidural space produced by pregnancy, the authors performed epiduroscopy in pregnant women. Using a flexible fiberscope, the authors evaluated the epidural space in 73 women undergoing lumbar epidural anesthesia. Patients were classified into three groups: a nonpregnant group (n = 21), a first trimester pregnant group (8-13 weeks, n = 23), and a third-trimester pregnant group (27-39 weeks, n = 29). A 17-gauge Tuohy needle was inserted using the paramedian technique and the loss-of-resistance method with 5 ml air. The epiduroscope was introduced into the lumbar epidural space via the Tuohy needle and was advanced approximately 10 cm in a cephalad direction from the needle tip within the epidural space. The differences in the epidural space among the three groups then was evaluated. The epiduroscopy showed that the epidural pneumatic space, after injection of a given amount of air, was narrower and the density of the vascular network greater in the third-trimester group than in the other two groups. The amount of engorged blood vessels was greater in the third and first trimester groups than in the nonpregnant group. The amount of bleeding at the needle tip and the amount of fatty and fibrous connective tissue did not differ among the three groups. Epidural blood vessels become engorged in the first trimester; the density of the vascular networks increase in the third trimester. These changes in the epidural space during pregnancy may affect the spread of epidural analgesia in pregnant women.