Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement.
Abstract
Background. Thoracic epidural catheters provide the best quality postoperative pain
relief for major abdominal and thoracic surgical procedures, but placement is one
of the most challenging procedures in the repertoire of an anesthesiologist. Most
patients presenting for a procedure that would benefit from a thoracic epidural catheter
have already had high resolution imaging that may be useful to assist placement of
a catheter. Methods. This retrospective study used data from 168 patients to examine
the association and predictive power of epidural-skin distance (ESD) on computed tomography
(CT) to determine loss of resistance depth acquired during epidural placement. Additionally,
the ability of anesthesiologists to measure this distance was compared to a radiologist,
who specializes in spine imaging. Results. There was a strong association between
CT measurement and loss of resistance depth (P < 0.0001); the presence of morbid obesity
(BMI > 35) changed this relationship (P = 0.007). The ability of anesthesiologists
to make CT measurements was similar to a gold standard radiologist (all individual
ICCs > 0.9). Conclusions. Overall, this study supports the examination of a recent
CT scan to aid in the placement of a thoracic epidural catheter. Making use of these
scans may lead to faster epidural placements, fewer accidental dural punctures, and
better epidural blockade.
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https://hdl.handle.net/10161/9371Published Version (Please cite this version)
10.1155/2015/545902Publication Info
Greene, NH; Cobb, BG; Linnau, KF; & Kent, CD (2015). Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss
of Resistance Depth during Thoracic Epidural Catheter Placement. Anesthesiol Res Pract, 2015. pp. 545902. 10.1155/2015/545902. Retrieved from https://hdl.handle.net/10161/9371.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Nathaniel Howard Greene
Assistant Professor of Anesthesiology

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