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

Abstract

Thoracic epidural analgesia (TEA) is known to have superior perioperative pain control over intravenous (IV) opioid analgesia in open abdominal surgery and is an essential enhanced recovery after surgery (ERAS) component in major abdominal surgeries. Recently, the ultrasound-guided thoracic epidural catheter placement (TECP) technique has drawn attention as an alternative for the traditional landmark palpation-based TECP or fluoroscopic-guided TECP technique due to the equipment’s improvement and increased popularity. However, only a small number of studies have introduced the advantages and usefulness of ultrasound-guided TECP. Moreover, a certain level of ultrasound-guided in-plane technique is required to perform this technique. Thus, to apply ultrasound-guided TECP correctly and reduce the likelihood of side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, device selection, and management. In this technical review, the authors have compared the advantages and disadvantages of ultrasound-guided TECP to traditional techniques and described its technical aspects from patient positioning, ultrasound probe selection and scanning, needle insertion under ultrasound guidance, and successful thoracic epidural catheter insertion confirmation through ultrasound imaging. Additionally, the recommended epidural catheter tip placement level with the extent of its injectate epidural spread is further described in this review in reference to a recent prospective study published by the authors.

Ultrasound-Guided Neuraxial Anaesthesia for Vaginal Hysterectomy in a Patient With Rheumatoid Arthritis

“…Epidural anaesthesia and analgesia are frequently used in the perioperative and postoperative periods in infra-umbilical and lower limb surgeries. It provides superior analgesia over intravenous analgesics [7]. The successful placement of the catheter in the epidural space by landmark-guided technique is highly dependent on the identification of lumbar interspaces [8].…”

Effect of Transradial Artery Catheterization on Shock Patients

“…In recent years, ultrasound guidance has been widely used in jugular catheterization, peripherally inserted central venous catheterization, and femoral venous catheterization, but there have been few applications reported in artery catheterization. For instance, ultrasound guidance for epidural surgery has gained popularity and interest, especially for lumbar epidural needle placement and catheterization, and its application in thoracic epidural surgeries has also been receiving attention [ 6 ]. Ultrasound-guided catheterization, as a “visual” new technology [ 7 ], makes the radial artery imaging clear and directly observes the radial artery orientation, anatomical variants, and the neighboring relationship with the surrounding tissues, which helps to find the best puncture point, improve the success rate, and reduce the injury with catheterization [ 8 ].…”