Fluoroscope guided epidural needle insertioin in midthoracic region: clinical evaluation of Nagaro's method

Abstract

BackgroundIn the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region.MethodsTwenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were placed in the prone position. The needle entry point was located at the junction between midline of the pedicle paralleled to the midline of the T7 vertebral body (VB) and the lower border of T7 VB on anteroposterior view of the fluoroscope. The needle touched and walked up the lamina, and the interlaminar space (ILS) was sought near the midline of the VB at the height of the pedicle.ResultsThe authors could not insert an epidural needle at T6-7 ILS in two patients and it was instead inserted at T5-6 ILS. However, other patients showed easy insertion at T6-7 ILS. The mean inward and upward angulations were 25° and 55° respectively. The mean actual depth and calculated depth from skin to thoracic epidural space were 5.1 cm and 6.1 cm respectively. Significant correlation between actual needle depth and body weight, podendal index (kg/m) or calculated needle depth was noted.ConclusionsThe fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.

Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures

“…With the increasing number of surgical and anaesthetic procedures being done in the thoracic vertebral column all over the world, a thorough knowledge of anatomical and radiological parameters is required. 5,24,[32][33][34][35] Advent of new assistive devices like c-arm, CT scan and navigation has made these procedures a bit easy; still knowledge of pre-procedure normative data is required to decrease complication rate. The present study presents the detailed CT morphometric data of the thoracic spine.…”

“…Thorough evaluation of anatomy can result in administration of block in much safe manner. 35 Table 3 shows the summarized various studies from the literature on thoracic or lumbar pedicles to decide on the novelty of idea of the present study.…”

Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

“…The last two layers (i.e., the ligamentum flavum and the ES) have a relevant difference in terms of densities; thus, the anesthesiologist perceives a tactile sensation called LOR when the needle breaches the ligamentum flavum and reaches the ES. Over the last years, both imaging-based techniques (e.g., ultrasound-based techniques, X-ray imaging techniques, near-infrared tracking systems) [ 9 , 10 , 11 , 12 ] and instrumented systems able to detect the LOR [ 13 , 14 , 15 , 16 , 17 , 18 ] have been investigated to guide the needle to the ES. However, a large part of the epidural analgesia procedures is performed blindly; thus, their success is operator-dependent [ 12 ].…”

Localization of epidural space: A review of available technologies

“…Certain investigators have evaluated the use of fluoroscopic guidance in localizing thoracic and lumbar EDS for preoperative placement of epidural catheters. [ 47 48 49 ] Though epidural localization could be easily performed with fluoroscopic guidance, routine use would be limited by the availability of fluoroscopy in preoperative settings. There are concerns of added risk due to radiation exposure and no published studies proving its advantage.…”