scholarly journals Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography

2004 ◽  
Vol 92 (2) ◽  
pp. 271-273 ◽  
Author(s):  
M.C. Kao ◽  
S.K. Tsai ◽  
W.K. Chang ◽  
H.T. Liu ◽  
Y.C. Hsieh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Insertion ◽  
Thoracic Epidural ◽  
Thoracic Epidural Catheter

scholarly journals Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Kosturakis ◽  
Jose Soliz ◽  
Jackson Su ◽  
Juan P. Cata ◽  
Lei Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Depth Measurement ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

Fluoroscopic Guidance Increases the Incidence of Thoracic Epidural Catheter Placement Within the Epidural Space

2017 ◽  
Vol 42 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Michelle C. Parra ◽  
Kristin Washburn ◽  
Jeremiah R. Brown ◽  
Michael L. Beach ◽  
Mark P. Yeager ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
Fluoroscopic Guidance ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Thoracic Epidural Catheter

Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation

2021 ◽  
pp. rapm-2021-102578
Author(s):  
Doo-Hwan Kim ◽  
Jong-Hyuk Lee ◽  
Ji Hoon Sim ◽  
Wonyeong Jeong ◽  
Dokyeong Lee ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Us Guidance ◽  
Thoracic Epidural Catheter ◽  
First Pass

Background and objectiveThoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement.Methods38 patients in the prone position were prospectively studied. After the target interlaminar space between T9 and T12 was identified, the needle was advanced under real-time US guidance and was stopped just short of the posterior complex. Further advancement of the needle was accomplished without US guidance using loss-of-resistance techniques to normal saline until the epidural space was accessed. Procedure-related variables such as time to mark space, needling time, number of needle passes, number of skin punctures, and the first-pass success rate were measured. The primary outcome was the success rate of real-time US-guided thoracic epidural catheter placement, which was evaluated using fluoroscopy. In addition, the position of the catheter, contrast dispersion, and complications were evaluated.ResultsThis study included 38 patients. The T10–T11 interlaminar space was the most location for epidural access. During the procedure, the mean time for marking the overlying skin for the procedure was 49.5±13.8 s and the median needling time was 49 s. The median number of needle passes was 1.0 (1.0–1.0). All patients underwent one skin puncture for the procedure. The first-pass and second-pass success rates were 76.3% and 18.4%, respectively. Fluoroscopic evaluation revealed that the catheter tips were all positioned in the epidural space and were usually located between T9 and T10 (84.2%). The cranial and caudal contrast dispersion were observed up to 5.4±1.6 and 2.6±1.0 vertebral body levels, respectively. No procedure-related complications occurred.ConclusionReal-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.Trial registration numberNCT03890640.

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