A Comparative Study of Median and Paramedian Techniques to Identify the Lower Thoracic Epidural Space and Catheter Insertion for Upper Abdominal Surgeries

Abstract

BACKGROUND Epidural is a central neuraxial blockade with various applications. The epidural space was first described by Corning in 1901. And Fidel Pages first used epidural analgesia in humans in 1921. Fidel Pages described the interspinous approach to the epidural space and reported satisfactory anaesthesia for abdominal procedures. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in Surgery, Obstetrics and Pain relief. Both single injection and catheter techniques can be used. Its versatility means it can be used as an anaesthetic, an adjuvant to general anaesthesia and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. This study compares the median and paramedian epidural techniques to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries. METHODS AND MATERIALSThis is a comparative, randomised, double-blinded prospective study comparing median and paramedian approaches to identify the lower thoracic epidural space and catheter insertion for upper abdominal surgeries in two groups of patients comprising of fi fty patients each. The observations were analysed using Epi info software and ANOVA measure for students' test and Chi-square test to compare the data between the two groups. RESULTSThis study shows paramedian approach of identification lower thoracic epidural space has less number of attempts, less incidence of dural tap, easy insertion of catheter, less incidence of pain, less time taken to identify the epidural space and less resistance to catheter insertion than the median approach. CONCLUSIONThe location of epidural space in patients posted for upper abdominal surgeries was found to be easier and has lesser complication by paramedian approach when compared to median epidural approach.

Predicting clinical entry point for thoracic epidural catheter insertion during paramedian approach: A prospective observational study

“…Also, paramedian approach was observed to have less epidural catheter tenting and more reliable cephalad catheter threading than midline approach. [ 11 ] In our study, all the cases were done in lateral decubitus with paramedian approach to locate epidural space.…”