This blinded, randomized study compares standard palpation to ultrasound-assisted landmark identification of the thoracic spine for thoracic epidural catheterization.
In this study, the investigators will utilize ultrasonography to identify midline bony landmarks including spinous processes, laminae, and intervertebral interspaces prior to the initial needle placement and compare this to standard palpation of the bony thoracic spine for thoracic epidural placement. The investigators will evaluate and compare the two needle localization techniques by the following outcomes: time to identify the epidural space by loss of resistance, needle passes, skin punctures, recovery room pain scores, and epidural success.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
70
Thoracic Epidural Placement
Delivery of epidural solution containing both bupivacaine 0.05%/hydromorphone0.01mg/mL solution
Delivery of epidural solution containing both bupivacaine 0.05%/hydromorphone0.01mg/mL solution
Virginia Mason Medical Center
Seattle, Washington, United States
Time to epidural space identification
Needle insertion through the skin until loss-of-resistance with slip syringe, evaluated by a blinded individual reviewing a video recording of the procedure.
Time frame: Estimated 10 minutes
Needle passes
Attempt to place needle into the interlaminar foramina. Needle tip movements toward midline and cephalad were counted as s single pass. Additional passes were counted when the needle was returned to a plane parallel to the skin.
Time frame: Estimated 10 minutes
Needle skin punctures
Complete needle withdrawal from the skin and re-insertion at new location
Time frame: Estimated 10 minutes
Pain Score
Numeric rating scale pain score on recovery room arrival, prior to IV analgesics.
Time frame: Through study completion, estimated 4 hours
Working epidural
Loss of temperature discrimination to ice and pain score \<= 5.
Time frame: Through study completion, estimated 4 hours
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