Combined Ultrasound and Nerve Stimulation‐Guided Thoracic Epidural Catheter Placement for Analgesia Following Anterior Spine Fusion in Scoliosis

Abstract

Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. This case report describes a safe, effective technique for placing a thoracic EP catheter in a young patient undergoing anterior spine fusion surgery by thoracotomy. The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter. The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion.

Feasibility and Efficacy of Preoperative Epidural Catheter Placement for Anterior Scoliosis Surgery

“…Despite concerns about feasibility, 16,17 we have shown that preoperative epidural catheter insertion can be performed without raising significant concerns and a high success rate of 96%, corresponding to that reported in the nonscoliotic spine. 18 Obstacles to TEC placement in the scoliotic spine are most often caused by the axial rotation of the vertebral bodies and angulation of the spinal processes.…”

Ultrasonographic Measurement of the Ligamentum Flavum Depth; Is It a Reliable Method to Distinguish True and False Loss of Resistance?

“…At the level of the thoracic and cervical spine, visualization of the epidural space is much more difficult than that in the lumbar spine but there are a few studies that have been published about the clinical utility of the ultrasound-guided neuraxial technique [11,21,22]. Correlation was excellent in all studies (Pearson correlation coefficients, 0.80-0.99), whether measurements were made in the sagittal, oblique, or transverse views.…”

Ultrasonography of the Adult Thoracic and Lumbar Spine for Central Neuraxial Blockade

“…Only three articles pertained to ultrasound imaging of the thoracic spine. 11,16,63 The methodology and results of the RCTs and observational studies are summarized in tables 2 and 3.…”

“…It is only logical that ultrasound would be most helpful in patients with poor or abnormal anatomic landmarks, and this is supported by numerous case reports of successful ultrasound-guided neuraxial block in patients with marked obesity (five reports), 17,20,62,67,75 previous spinal surgery and instrumentation (seven reports), 18,59 -61,65,66,68 and spinal deformity (four reports). 16,32,58,63 In one of the five published RCTs, Grau et al 8 specifically enrolled 72 parturients in whom neuraxial block was anticipated to be difficult because of the presence of spinal deformity, obesity (body mass index more than 33 kg/m 2 ), or a history of previous difficulty. Patients in whom ultrasound imaging was used underwent fewer needle passes (1.5 Ϯ 0.9 vs. 2.6 Ϯ 1.4, P Ͻ 0.001) at fewer spinal interspaces (1.3 Ϯ 0.5 vs. 1.6 Ϯ 0.7, P Ͻ 0.05) than did the control group.…”