Accuracy of the Thoracic Epidural Catheter Insertion Confirmed by Fluoroscopic Imaging

Chicago Anesthesia Pain Specialists60 enrolled

Overview

In patients scheduled for thoracic surgery or upper abdominal surgery, investigators will determine the accuracy of the epidural catheter placement by using fluoroscopic imaging. Previous studies have drawn contradictory conclusions based the potential flaw assumption of 100% success rate for correct epidural catheter placement in the thoracic region.

Thoracic epidural analgesia (TEA) is a key tool in management of pain after thoracic or upper abdominal surgery. TEA optimizes pain relief while minimizing the use of systemic opioids, thus reducing the duration of postoperative ileus. TEA also attenuates surgical stress response and allows for early mobilization. Despite all the touted benefits of TEA, much controversy limits its use for post surgical pain due to fear of exceedingly rare, if not entirely theoretical complication of epidural hematoma. Beneficial effects of TEA require that catheter placement and infusate be targeted at the thoracic segments innervating injured skin, muscle, and bone from which pain input originates. The purpose of this study is to determine the accuracy of thoracic epidural continuous catheter insertion by using fluoroscopic imaging.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Patients Undergoing Thoracic Surgery Patients Undergoing Upper Abdominal Surgery

Interventions

Fluoroscopic imagingPROCEDURE

Contrast media (5 mL) will be injected through the catheter and fluoroscopic images will be obtained and saved in the lateral and antero-posterior projections.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18- 80 years old patients * Patients undergoing thoracic surgery * Patients undergoing upper abdominal surgery Exclusion Criteria: * Severe Aortic Valve stenosis * Active Neurologic Disease * Allergy to lidocaine or bupivacaine * Allergy to iodine-based contrast * Cutaneous Disorders at epidural insertion site * Preoperative impaired coagulation status * Pregnancy

Locations (1)

Advocate Illinois Masonic Medical Center

Chicago, Illinois, United States

Outcomes

Primary Outcomes

Presumed intervertebral level of epidural catheter

At the time of thoracic epidural catheter insertion

Time frame: During procedure

Secondary Outcomes

Radiologic confirmation of epidural catheter placement

Radiology department will assess within one week after the procedure the images, to confirm the epidural catheter placement.

Time frame: Post procedure within one week.

Change in Numeric Rating Pain Score from baseline

1, 24, and 48 hrs after the end of the surgery.

Time frame: 1, 24 and 48 hrs

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.