Real-Time Ultrasound-Assisted Thoracic Epidural Placement

Abstract

The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. We discuss a safe and consistent technique using true real-time ultrasound visualization of the needle with a paramedian sagittal oblique view to improve the consistency of placing an epidural in the thoracic spine for postoperative analgesia. Successful epidural placement was achieved in every patient. All catheters were found to be effective for use in the postoperative phase.

Real-time ultrasound guided thoracic epidural catheterization: a technical review

“…Since the thoracic spines are dorsally convex at shallow depths as compared the lumbar level spines, a linear probe is sufficient to identify the main object around the epidural space in majority of cases, unless the patient is very obese. This is supported by Pak and Gulati's previous study [12], which performed thoracic epidural catheterization in a similar manner, determining the mean parasagittal distance from the skin to the epidural space was 5.2 ± 1.1 cm. Aside from this, it is also helpful to use a linear probe when accurately checking the needle tips in real time is essential.…”

“…Recently, the ultrasound-guided TECP technique has drawn attention with the equipment's improvement and increasing popularity [10,11]. Despite this, only a small number of studies have introduced the advantages and usefulness of the technique [7,12,13]. Thus, in this technical review, the authors investigated the advantages of the ultrasound-guided TECP technique as compared to the other two.…”

Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block versus Thoracic Epidural Analgesia for Post-Thoracotomy Pain: A Prospective, Randomized, Clinical Trial

“…In group II, the thoracic epidural catheter was inserted under ultrasound guide preoperative. The ultrasound visualization of the needle improves the continuation of placing an epidural in the thoracic spine for postoperative analgesia [9].…”

Should we assess the epidural anaesthetic spread during ultrasound-guided thoracic paravertebral block?

“…The ES when performing ultrasound-guided cervical spinal nerve root injection of anaesthetic has been directly visualised with ultrasound and demonstrated with CT scan by Won et al 3 and there are various articles showing the possibility to visualise epidural space in the thoracic and lumbar spine 4,5 ; thus the ES when performing PVB could be detected with ultrasound as well as the spread in the more superficial surrounding structures, for example the spread along intercostal nerves, which also can be a target for ultrasound-guided injections.…”