Paths of thoracic epidural catheters in children undergoing the Nuss procedure for pectus excavatum repair

Abstract

Purpose To investigate the paths of thoracic epidural catheters in children, this retrospective study was performed. Methods We investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery. Results The median level for the catheter tip location was T3 (range C6–T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2–3 cm (1–1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6–T4)] than in those with curved or coiled paths after the initial 2–3 cm [median (range) T4 (T2–T7)] (p < 0.0001). Conclusions Our findings indicate that the course of epidural catheters in children is unpredictable after the first 2–3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.

The height of the operating table affects the performance of residents in combined spinal and epidural anesthesia training by affecting the vision of the puncture needle: a randomized controlled trial

“…This may be because the residents were more likely to insert the epidural needle near the left side of the patient, and so the nerve roots on the left side of the epidural space were more likely to be irritated and cause paresthesia when the catheter was inserted. The catheters used in our study were stiff, which may have induced greater incidence of paresthesia and intravascular cannulation than wire-embedded catheters [ 6 – 8 ]. A previous study reported that the angle formed between the patient’s back skin and the needle in the coronal plane was greater than 90° in groups U and R [ 3 ]; this might increase the risk of the spinal needle being inserted closer to the right side compared with the epidural needle.…”