Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

Background.Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter.Methods.This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD) on computed tomography (CT) to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging.Results.There was a strong association between CT measurement and loss of resistance depth (P<0.0001); the presence of morbid obesity (BMI>35) changed this relationship (P=0.007). The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individualICCs>0.9).Conclusions.Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

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Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate

Regional Anesthesia and Pain Medicine ◽

10.1097/aap.0000000000000637 ◽

2017 ◽

Vol 42 (5) ◽

pp. 649-651 ◽

Cited By ~ 10

Author(s):

Yehoshua Gleicher ◽

Oskar Singer ◽

Stephen Choi ◽

Paul McHardy

Keyword(s):

Epidural Catheter ◽

Operating Room ◽

Failure Rate ◽

Catheter Placement ◽

Operating Room Efficiency ◽

Epidural Catheter Placement ◽

Thoracic Epidural ◽

Thoracic Epidural Catheter ◽

Block Area

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Patient-Controlled Epidural Analgesia/Continuous Epidural Catheters

10.2310/anes.15039 ◽

2016 ◽

Author(s):

Devin Peck

Keyword(s):

Epidural Catheter ◽

Local Anesthetics ◽

Catheter Placement ◽

Labor Pain ◽

Abdominal Incision ◽

Tumor Spread ◽

Epidural Catheter Placement ◽

Thoracic Epidural ◽

Cord Injury ◽

Epidural Catheters

Although useful for management of many types of pain, the most common indication for epidural catheter placement is for management of labor pain. High lumbar and thoracic epidural catheter placement has gained increasing popularity in recent years for the management of postoperative pain. The technique is most commonly employed for procedures in which a thoracic or an extensive abdominal incision is anticipated. Absolute contraindications for epidural catheter placement include patient refusal, uncorrected hypovolemia, increased intracranial pressure, local infection at the planned site of insertion, and patient allergy to amide/ester local anesthetics. Relative contraindications include coagulopathy, an uncooperative patient, severe anatomic abnormalities of the spine, sepsis, and hypertension. The advantages include attenuation of the sympathetic response to surgical stimulation and pain; effects on the cardiovascular, respiratory, and gastrointestinal systems; thromboprotective effects; and possibly limitation of tumor spread. The risks of epidural catheter placement include epidural hematoma, infection, nerve or spinal cord injury, dural puncture, or respiratory or cardiovascular depression from a high block. Epidural opioids provide analgesia without causing motor or sympathetic blockade. Epidurally administered local anesthetics may result in decreased postoperative ileus, nausea, vomiting, and sedation, which can be associated with opioids. Local anesthetics and opioids act additively or synergistically and, when used together, can lead to a reduction in the dose of each drug.

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Thoracic Epidural Catheter Placement Using a Paramedian Approach with Cephalad Angulation in Three Dogs

Veterinary Surgery ◽

10.1111/j.1532-950x.2012.00990.x ◽

2012 ◽

Vol 41 (7) ◽

pp. 884-889 ◽

Cited By ~ 6

Author(s):

Paolo Franci ◽

Elizabeth A. Leece ◽

Federico Corletto

Keyword(s):

Epidural Catheter ◽

Catheter Placement ◽

Epidural Catheter Placement ◽

Thoracic Epidural ◽

Thoracic Epidural Catheter

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Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

Pain Research and Treatment ◽

10.1155/2015/470240 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Alyssa Kosturakis ◽

Jose Soliz ◽

Jackson Su ◽

Juan P. Cata ◽

Lei Feng ◽

...

Keyword(s):

Computed Tomography ◽

Epidural Catheter ◽

Epidural Space ◽

Depth Measurement ◽

Thoracic Epidural ◽

Patient Demographics ◽

Loss Of Resistance ◽

Computed Tomography Scans ◽

The Mean ◽

Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

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