Comparison of Thoracic Epidural Pressure in the Prone and Lateral Decubitus Position

Study Overview
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Brief Summary
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It is reported that the distribution of contrast medium had an obvious correlation with the extent of sensory analgesia after injection of LA. Our previous study showed that different posture (prone vs. lateral decubitus) resulted in different degree of contrast medium spread. We supposed that differences of epidural pressure between diverse postures might be one factor contributing those differences of epidurography. This study was designed to compare the epidural pressure and extent of spread of epidurography between prone and lateral decubitus position

Detailed Description
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It is known that postoperative pain after thoracotomy or lobectomy is very severe, therefore, intraoperative or postoperative pain management using continuous thoracic epidural catheterization is suggested good option to prevent this potential complication. The spread of local anesthetics is influenced by various factors including volume, location of needle insertion, speed of injection, patient position, age, weight and height. However, there are few studies about the effect of different patient position affeting the epidural pressure and the extent of spread of contrast medium during thoracic epidural catheterization. Studies of lumbar epidural blockade have shown that lateral position can produce 0-3 segment more to the dependent position compared to the supine position. When the same amount of local anesthetic was injected in supine of sitting position, the most cephalad level of spread was indifferent. Recent studies showed that neck flexion demonstrated significant cephalad spread of contrast dye in high thoracic epidural blockade. The purpose of this study was to compare and evaluate the changes of epidural pressure with extent of spread of contrast medium between different posture

Official Title
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Comparison of Extent of Epidurography and Thoracic Epidural Pressure in the Prone and Lateral Decubitus Position

Conditions
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Thoracic Epidural Injection

Intervention / Treatment
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* Procedure: thoracic epidural catheterization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: lung cancer liver cancer stomach cancer pancreas cancer Exclusion Criteria: coagulopathy infection previous spine fusion at thoracic level

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active Comparator: supine position<br>Active Comparator: supine position thoracic epidural catheterization with supine position | Procedure: thoracic epidural catheterization<br>* thoracic epidural catheterization thoracic epidural catheterization for the management of postoperative pain<br>|
| Active Comparator: Active Comparator: flexed lateral position<br>Active Comparator: flexed lateral position thoracic epidural catheterization with flexed lateral position | Procedure: thoracic epidural catheterization<br>* thoracic epidural catheterization thoracic epidural catheterization for the management of postoperative pain<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Epidural pressure | Epidural pressure (mmHg) measurement using pressure transducer between different posture | 15 minutes after the completion of the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Contrast dye assessment | Number of segment convered by contrast dye assessed through fluoroscopic image | 5 minutes after the completion of the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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epidurography epidural pressure patient posture