Thoracic epidural analgesia and anesthesia are effective in improving the quality of intraoperative and postoperative pain relief during thoracic and abdominal surgical procedures. Conventional epidural techniques have significant limitations. Due to the anatomic characteristics of the thoracic versus the lumbar intervertebral spaces, the insertion requires a more technically challenging paramedian approach. The safety and feasibility of bedside ultrasonography for the lumbar spine has already been established and it proves to be a valuable tool for neuraxial anesthesia in obstetric anesthesia
• The feasibility and the reliability of US imaging for the thoracic spine has been proven by comparing the findings of ultrasound scans to MRI measurements, which is the standard imaging technique for the depiction of the spine. Pre-puncture US assessment may contribute to the safety and efficacy of the thoracic epidural technique. The purpose of this study is to compare the ultrasound-guided thoracic epidural insertion technique with the conventional anatomic landmarking technique of contacting bone and walking-off the lamina
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Ultrasound-guided technique
Landmark-guided technique
University Health Network - Toronto General Hospital
Toronto, Ontario, Canada
Mount Sinai Hospital
Toronto, Ontario, Canada
Needle redirections
Number of needle redirections defined as the need to withdraw the epidural needle for the purpose of continuing on a different angle (sagittal or axial plane)
Time frame: 30 minutes
Bony contacts
number of bony contacts during the needle insertion
Time frame: 30 minutes
New insertion point
need to re-insert the epidural needle in the same interlaminar space, but using different insertion point
Time frame: 30 minutes
Number of insertions
number of different interlaminar space insertions
Time frame: 30 minutes
duration of ultrasound scanning
duration of ultrasound scanning
Time frame: 30 minutes
duration of epidural procedure
duration of epidural procedure
Time frame: 30 minutes
complications during epidural insertion
complications during epidural insertion
Time frame: 30 minutes
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