Ultrasound-assisted Thoracic Epidural Catheter Insertion
Condition: Abdominal Neoplasm; Thoracic Neoplasm
MeSH terms: Neoplasms; Thoracic Neoplasms; Abdominal Neoplasms
Study type: Interventional

Summary: 
      The aim of the present study is to access the success rate of ultrasound-guided thoracic
      epidural catheter insertion, using fluoroscopy.
    

Detailed description: 
      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.
    

Intervention name(s): Ultrasound-guided TECI
Intervention type(s): Procedure
Intervention description(s): When performing an ultrasound-guided thoracic epidural catheter insertion (TECI), an 18-gauge Tuohy needle will be used for interlaminar epidural access. All procedures will be performed with a paramedian approach under ultrasound-guidance and using the loss of resistance technique with saline. If the needle is deemed to be in the epidural space when the loss of resistance occurred, fluoroscopic views will be obtained to confirm which the catheter tip is located in the epidural space or not.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Ultrasound; Thoracic epidural catheter insertion; Fluoroscopy