Which Is a Better Position for Insertion of a High Thoracic Epidural Catheter: Sitting or Lateral Decubitus?

Nishi, Makoto; Usukaura, Ai; Kidani, Yoko; Tsubokawa, Tsunehisa; Yamamoto, Ken

doi:10.1053/j.jvca.2006.03.019

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…9 The sitting position has been described to result in shorter insertion times and a trend towards higher accuracy at the first attempt than the lateral position, but at the cost of more vagal reflexes, and with comparable final success rates. 10 In combined spinal -epidural anaesthesia for Caesarean section, no differences were reported for insertion times, 11 while another study found more technical difficulties in the lateral compared with the sitting position. 12 Lateral positioning increases the distance from the skin to the epidural space.…”

Section: Patient Positionmentioning

confidence: 99%

Failed epidural: causes and management

Hermanides

Hollmann

Stevens

et al. 2012

British Journal of Anaesthesia

335

202

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Failed epidural anaesthesia or analgesia is more frequent than generally recognized. We review the factors known to influence the success rate of epidural anaesthesia. Reasons for an inadequate epidural block include incorrect primary placement, secondary migration of a catheter after correct placement, and suboptimal dosing of local anaesthetic drugs. For catheter placement, the loss of resistance using saline has become the most widely used method. Patient positioning, the use of a midline or paramedian approach, and the method used for catheter fixation can all influence the success rate. When using equipotent doses, the difference in clinical effect between bupivacaine and the newer isoforms levobupivacaine and ropivacaine appears minimal. With continuous infusion, dose is the primary determinant of epidural anaesthesia quality, with volume and concentration playing a lesser role. Addition of adjuvants, especially opioids and epinephrine, may substantially increase the success rate of epidural analgesia. Adjuvant opioids may have a spinal or supraspinal action. The use of patient-controlled epidural analgesia with background infusion appears to be the best method for postoperative analgesia.

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Section: Patient Positionmentioning

confidence: 99%

Failed epidural: causes and management

Hermanides

Hollmann

Stevens

et al. 2012

British Journal of Anaesthesia

335

202

View full text Add to dashboard Cite

show abstract

“…Both sitting and lateral decubitus positions have shown similar success rates of thoracic epidural access. 7,8 The lateral decubitus position has some clinical advantages. 9,10 The length of the posterior longitudinal ligament (PLL) represents the amount of space that is available for the passage of the ultrasound beam from the laminae to the PLL.…”

mentioning

confidence: 99%

The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position

Byon

Song

et al. 2016

Regional Anesthesia and Pain Medicine

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“…In this study, we performed thoracic epidural blockade in the lateral decubitus position, which yielded a slightly lower success rate than that reported previously for the sitting position (18). Vagal reflex or hypotensive events can occur in thoracic epidural blockade (19).…”

Section: E333mentioning

confidence: 91%

Comparison of Thoracic Epidural Access with Lateral Decubitus and Shoulder Rotation Positions for Repeat Thoracic Epidural Blockade

et al. 2021

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Background: Shoulder rotation has been shown to increase the acoustic window of ultrasound for thoracic epidural access. However, this effect of shoulder rotation has not yet been confirmed in clinical practice. Objective: This study aimed to evaluate the effects of shoulder rotation on the thoracic epidural blockade in patients with acute or chronic pain in the thoracic region. Study Design: Prospective crossover trial. Setting: Pain clinic of our university in the Republic of Korea. Methods: Forty patients aged 20 – 80 years with acute or chronic pain in the thoracic region who were scheduled to undergo thoracic epidural blockade more than twice. Interventions: The patients underwent repeated fluoroscopy-guided thoracic epidural blockade via the paramedian approach in the lateral decubitus position either with or without shoulder rotation. The primary outcome measure was the attempt time to the confirmed spread of contrast. The number of attempts, total procedure time, vertical interpedicular distance, contrast spreading length, and complications were compared between the 2 positions. Results: The median attempt times in the lateral decubitus and shoulder rotation positions were 138.8 and 132.5 seconds, respectively, and this difference was significant (P = 0.004). Compared with the lateral decubitus position, the shoulder rotation position was also associated with a significantly lower number of attempts (P = 0.03), shorter total procedure time (P < 0.001), and greater vertical interpedicular and contrast spreading distances (P < 0.001 and P = 0.02, respectively). Limitations: The operator in this study was not blinded to the patient groups. Other researchers observed the operator’s procedure and evaluated and recorded the data in an attempt to overcome this bias. However, it was difficult to completely avoid the bias. Second, epidural blockade was performed at various levels (T3–11), and the anatomical features vary among thoracic spine levels. Conclusions: The study findings demonstrate the clinical benefits of the shoulder rotation position versus the lateral decubitus position in terms of successful epidural access during thoracic epidural blockade using the paramedian approach. Key words: contrast spreading length, fluoroscopy, lateral decubitus position, paramedian approach, shoulder rotation, thoracic epidural blockade, vertical interpedicular distance

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Which Is a Better Position for Insertion of a High Thoracic Epidural Catheter: Sitting or Lateral Decubitus?

Cited by 14 publications

References 14 publications

Failed epidural: causes and management

Failed epidural: causes and management

The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position

Comparison of Thoracic Epidural Access with Lateral Decubitus and Shoulder Rotation Positions for Repeat Thoracic Epidural Blockade

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