Abdominal Neoplasm Clinical Trial
Official title:
Evaluation of the Accuracy of Real-time Ultrasound-assisted Thoracic Epidural Catheter Insertion: a Pilot Study
The aim of the present study is to access the success rate of ultrasound-guided thoracic epidural catheter insertion, using fluoroscopy.
Thoracic epidural anesthesia has been associated with reduced acute postoperative pain for a
wide variety of surgical procedures. It has also been associated with reductions in
perioperative cardiac stress, chronic post-thoracotomy pain, and improvements in
postoperative pulmonary function. Although a variety of methods can be used to confirm the
position of the epidural needle in the epidural space, a blind technique and fluoroscopic
guided approach are a widely used method. A thoracic epidural block is a relatively more
difficult procedure than procedures used in other regions, because the spinous process of the
thoracic vertebra is longer than that of the lumbar vertebra, and the area through which the
needle can approach the epidural space is relatively smaller due to an acute angle and larger
distance between the skin and the epidural space. Therefore, the success rate of thoracic
epidural intervention is only about 68% under a blind technique due to inadequate position of
the needle tip, misplacement, occlusion, and migration of the catheter.
Although fluoroscopic guided thoracic epidural intervention is the safest and most accurate
method to identify the correct anatomical structures and confirm the epidural space with
contrast medium, its use is limited because of the difficulty of using fluoroscope and the
burden of radiation exposure. As the use of ultrasound has become popularized and universal,
it has been widely used in regional anesthesia and analgesia, has continuously replaced the
modality such as a blind technique and fluoroscopic guidance. Ultrasound-guided thoracic
epidural catheter insertion was also recently investigated, and then it was conducted
successfully in 15 cases of thoracic and upper abdominal surgery. Moreover, it showed several
advantages including lowering the number of needle passes and increasing the success rate.
However, it has not yet been studied how accurately the catheter is located in the thoracic
epidural space during thoracic epidural catheter insertion using real-time ultrasound.
Although it is possible to speculate the success of the thoracic epidural catheterization
clinically, the identification of the location of the catheter is only possible under
fluoroscopic guidance. Therefore, in the present study, we aimed to confirm the success rate
of ultrasound-guided thoracic epidural catheter insertion, using fluoroscopy with contrast
medium.
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