A COMPARATIVE STUDY OF MEDIAN AND PARAMEDIAN TECHNIQUES TO IDENTIFY THE LOWER THORACIC EPIDURAL SPACE AND CATHETER INSERTION FOR UPPER ABDOMINAL SURGERIES

Objective: To describe the technical characteristics of thoracic epidural analgesia after upper abdominal surgery. Subjects and methods: A prospective descriptive study, 50 patients aged 18 years or older, with ASA I - III, indicated upper abdominal surgery had epidural catheter placement at the thoracic interspinal space of T7 - T8 or T8 - T9. The epidural space was determined by loss of resistance technique. Failure to define the epidural space, perforation of the dura, median or paramedian line of needle insertion, distance from the skin to the epidural space, displacement or catheter occlusion during analgesia were recorded. Results: Success rate was 98%, the epidural space were not identified in 2%, perforation of the dura in 4%. Needle insertion via median line was in 80.9% and paramedian one in 19.1%. The distance from the skin to epidural space of 4 to 5 cm, 3-4 cm and over 5 cm was 58%, 24.5% and 18.4%, respectively. Catheter was clogged immediately after placement when performing dose test was 2.04%, dislodgement of catheter when transporting patients from the operating to the recovery room and occlusion on the second day was 2.04%. Conclusion: Catheter insertion in analgesia following upper abdominal surgery has a high success rate, when the median technique of needle insertion failed, the paramedian was an alternative. Care for the catheter must be taken during pain management. Key words: Technical characteristics, thoracic epidural analgesia

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Comparative study of continuous thoracic epidural infusion of ropivacaine-fentanyl v/s bupivacaine-fentanyl in upper abdominal surgery for post operative analgesia

MedPulse International Journal of Anesthesology ◽

10.26611/10151624 ◽

2020 ◽

Vol 16 (2) ◽

pp. 41-50

Author(s):

Rajeev Navaria ◽

Keyword(s):

Abdominal Surgery ◽

Comparative Study ◽

Epidural Infusion ◽

Thoracic Epidural ◽

Upper Abdominal Surgery ◽

Upper Abdominal

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Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography

British Journal of Anaesthesia ◽

10.1093/bja/aeh053 ◽

2004 ◽

Vol 92 (2) ◽

pp. 271-273 ◽

Cited By ~ 20

Author(s):

M.C. Kao ◽

S.K. Tsai ◽

W.K. Chang ◽

H.T. Liu ◽

Y.C. Hsieh ◽

...

Keyword(s):

Computed Tomography ◽

Epidural Catheter ◽

Epidural Space ◽

Catheter Insertion ◽

Thoracic Epidural ◽

Thoracic Epidural Catheter

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Thoracic Epidural Anesthesia Via the Lumbar Approach in Infants and Children

Anesthesiology ◽

10.1097/00000542-199606000-00006 ◽

1996 ◽

Vol 84 (6) ◽

pp. 1312-1316 ◽

Cited By ~ 61

Author(s):

D. Blanco ◽

J. Llamazares ◽

R. Rincon ◽

M. Ortiz ◽

F. Vidal

Keyword(s):

Abdominal Surgery ◽

Epidural Space ◽

Dural Puncture ◽

Thoracic Epidural ◽

Thoracic Level ◽

Catheter Tip ◽

Upper Abdominal ◽

Reliable Sign ◽

In Infants And Children ◽

Segmental Approach

Background In upper abdominal or chest surgery, the segmental approach to thoracic epidural space has the advantage of reducing the total dose of local anesthetic needed. This approach, however, is associated with greater risk of neurologic damage or dural puncture. The aim of this study was to assess the success and the degree of difficulty in advancing a 19-G catheter from the lumbar epidural space to the thoracic level in patients aged 0-96 months. Methods In 39 patients undergoing abdominal surgery, the cutaneous distance between the L4-L5 and T10-T11 interspaces was measured, and an appropriate length of 19-G catheter was inserted into the epidural space through an 18-G Tuohy needle with bevel directed cephalad. The intent was to advance the full length of catheter measured to reach the objective. The tips were observed radiologically, and all those positioned cephalad to the T12 level were considered well placed. The degree of difficulty in advancing the catheter was classified as easy, difficult, or impossible. Complications reported were vascular and/or spinal puncture and difficulty removing the catheter. Results The catheter tip reached T10-T12 in 7 patients, L2 in 1, L3 in 8, and L4-L5 in 23. Forty-eight percent of the catheters described as easily advanced remained at the L4-L5 level, and only 22% reached the desired level. Difficult insertions occurred in eight patients, in whom the objective was never reached. One case of intravascular insertion was reported. All catheters were removed without difficulty. Conclusions The 19-G catheter is inappropriate for use in reaching the thoracic epidural space by the lumbar approach. Easy entrance of a catheter is not a reliable sign of having reached the desired level.

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