Prediction of the Distance from Skin to Mid-Thoracic Epidural Space by Computed Tomography

Lee, Sung‐Jin; Choi, Seung Ho; Kim, Min Soo; Shin, Yang Sik

doi:10.4097/kjae.2005.48.6.605

Cited by 4 publications

(1 citation statement)

References 2 publications

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“…In this study, the correlation between the actual depth extending to the thoracic epidural space and the CT-guided calculated depth was also examined. The calculated depth was found to be larger than the actual depth, a finding consistent with the results reported by Kao et al [ 13 ] in a study in which the depth was measured in the lower thoracic region (T10-11), yet contradictory to the results of Lee et al [ 14 ], in whose study the actual depth in the midthoracic region (T7-8) was found to be larger than the calculated depth. The reason why the calculated depth was larger than the actual depth in our study is presumably that the position the patients were instructed to assume (i.e., the prone position, with support from a 10 cm deep pillow) had tightened the skin more than in the supine position where, as in a CT scan, the patients lie on their back, with their arms raised.…”

Section: Discussionsupporting

confidence: 77%

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

Kim

Shin

et al. 2012

Korean J Anesthesiol

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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.

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Section: Discussionsupporting

confidence: 77%

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

Kim

Shin

et al. 2012

Korean J Anesthesiol

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Prediction of midline depth from skin to cervical epidural space by lateral cervical spine X-ray

et al. 2017

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Background:Previous studies have shown that measuring the distance from the skin to the ligamentum flavum by ultrasound preceding cervical epidural block can be beneficial in excluding false loss of resistance. However, the measurement value using ultrasound may vary depending on the degree of operator experience. Therefore, we aimed to determine the depth from skin to cervical epidural space by using lateral cervical spine X-ray, which is a more intuitive method. Methods: We enrolled 102 adult patients who were scheduled to undergo cervical epidural anesthesia for vascular bypass surgery of upper arm. After attaching a steel rod on the needle insertion site, lateral cervical spine X-ray was taken before the epidural procedure. We measured the distance from the steel rod to the midpoint of interlaminar space on the spinolaminar line. The X-ray depth was compared with needle depth. Results: Of the 102 enrolled patients, 18 patients including 13 in whom we were unable to measure X-ray depth were excluded from the analysis. In total, 84 patients were included in the analysis. Concordance correlation coefficient between the X-ray-measured depth and needle depth was 0.925. Bland-Altman analysis indicated

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What is the Optimal Angle of Needle Insertion in Korean Young Adult Male during Paramedian Spinal Puncture? A Radiological Study

Kim

Bae

et al. 2006

Korean J Anesthesiol

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Prediction of the Distance from Skin to Mid-Thoracic Epidural Space by Computed Tomography

Cited by 4 publications

References 2 publications

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

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

Prediction of midline depth from skin to cervical epidural space by lateral cervical spine X-ray

What is the Optimal Angle of Needle Insertion in Korean Young Adult Male during Paramedian Spinal Puncture? A Radiological Study

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