Evaluation of Ultrasound-Assisted Thoracic Epidural Placement in Patients Undergoing Upper Abdominal and Thoracic Surgery

Auyong, David B.; Hostetter, Lucy S.; Yuan, Stanley C.; Slee, April; Hanson, Neil A.

doi:10.1097/aap.0000000000000540

Cited by 48 publications

(34 citation statements)

References 18 publications

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“…[3][4][5][6][7] Preprocedural imaging, however, still requires blind advancement of the epidural needle and does not reduce the time or number of needle redirections required to place a thoracic epidural catheter. 8 Interest in using real-time US visualization during needle advancement to improve rates of catheter placement at the lumbar spine has recently developed. 9,10 However, this technique is difficult at the thoracic spine, given the narrow interlaminar space and steep angulation of the spinous processes, which provide poor US visibility.…”

mentioning

confidence: 99%

Real-Time Ultrasound-Assisted Thoracic Epidural Placement

Pak

Gulati

2018

Regional Anesthesia and Pain Medicine

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The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. We discuss a safe and consistent technique using true real-time ultrasound visualization of the needle with a paramedian sagittal oblique view to improve the consistency of placing an epidural in the thoracic spine for postoperative analgesia. Successful epidural placement was achieved in every patient. All catheters were found to be effective for use in the postoperative phase.

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mentioning

confidence: 99%

Real-Time Ultrasound-Assisted Thoracic Epidural Placement

Pak

Gulati

2018

Regional Anesthesia and Pain Medicine

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“…The use of pre-procedural ultrasonography for TEA catheter insertion has shown its value in postoperative analgesia in a recent study 46. Ultrasonography has shown utility in needle placement by statically (not dynamically) identifying the ligamentum flavum and dura mater.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography has shown utility in needle placement by statically (not dynamically) identifying the ligamentum flavum and dura mater. Nevertheless, catheter placement cannot be verified with this technique, which is a major limitation of this technique 46–48. Furthermore, the use of the CT scan to determine catheter placement in TEA has been studied by Motamed et al who were unable to correlate the vertebral level ascertained by CT scan with a clinically assessed dermatomal level 40.…”

Section: Discussionmentioning

confidence: 99%

The impact of fluoroscopic confirmation of thoracic imaging on accuracy of thoracic epidural catheter placement on postoperative pain control

Aijaz

Candido

Anantamongkol

et al. 2018

LRA

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BackgroundThoracic epidural analgesia (TEA) provides superior postoperative pain control compared to parenteral opioids after major thoracic and abdominal surgeries. However, some studies with respect to benefits of continuous TEA have shown mixed results. The purpose of this study was to determine the rate of successful TEA catheter insertion into the epidural space using contrast fluoroscopy and the impact of placement location on postoperative analgesia and opioid use.Patients and methodsAfter Advocate health care institutional review board approval, we conducted a prospective, open-label, single intervention study on patients undergoing thoracic or upper abdominal surgery. A thoracic paramedian epidural approach and a loss of resistance to saline technique were used to place an epidural catheter above the T11 level and fluoroscopic images with injected contrast were taken to locate the catheter tip in the epidural space.ResultsTwenty-five subjects were included in the study, of which 3 catheters (12%) were not identified as being in the epidural space. We found an average difference of 1.5 vertebral levels between clinical and radiological assessments of catheter tips. Thirteen catheters (52%) were more than 1 vertebral level away from the clinically assessed level. No significant difference was found in the pain scores at 1, 24, and 48 hours after surgery between patients with correct versus incorrect catheter placement. Less opioids were used in the correct catheter placement group at 24 hours (256 morphine milligram equivalent [MME] vs 201 MME) and at 48 hours after surgery (250 MME vs 173 MME), but it was not statistically significant (p=0.149 and p=0.068, respectively).ConclusionImprovement in assuring success in the technique for TEA catheter placement following major thoracic or upper abdominal surgery exists, for which contrast-enhanced fluoroscopy might be a promising solution.

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“…Though it has been suggested that preprocedural sonography of the thoracic spine can provide clinical benefit by defining the spinal anatomy, 11 this advantage was refuted in a recent randomized trial. 12 Doppler ultrasound has recently been shown to help visualize epidural catheters placed in the lumbar epidural space; nevertheless, efficacy of this technique has not been demonstrated in the thoracic spine. 13 Epidural waveform analysis has been used to confirm the presence of the epidural needle or catheter in the epidural space.…”

mentioning

confidence: 99%

“…Certains ont suggéré qu'une échographie de la colonne thoracique avant une procédure pouvait avoir un bénéfice clinique en précisant l'anatomie vertébrale, 11 mais cet avantage a été réfuté dans une récente étude randomisée. 12 On a aussi montré récemment que le Doppler contribuait à la visualisation des cathéters périduraux placés dans l'espace péridural lombaire; néanmoins, l'efficacité de cette technique n'a pas été démontrée au niveau thoracique. 13 L'analyse du tracé de la pression péridural a été utilisée pour confirmer la présence d'une aiguille ou d'un cathéter dans l'espace péridural.…”

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