Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement
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 benef...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Anesthesiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2015/545902 |
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| author | Nathaniel H. Greene Benjamin G. Cobb Ken F. Linnau Christopher D. Kent |
| author_facet | Nathaniel H. Greene Benjamin G. Cobb Ken F. Linnau Christopher D. Kent |
| author_sort | Nathaniel H. Greene |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0ad9e1732e51492e9d959be5e337f376 |
| institution | Kabale University |
| issn | 1687-6962 1687-6970 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
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| series | Anesthesiology Research and Practice |
| spelling | doaj-art-0ad9e1732e51492e9d959be5e337f3762025-02-03T01:30:50ZengWileyAnesthesiology Research and Practice1687-69621687-69702015-01-01201510.1155/2015/545902545902Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter PlacementNathaniel H. Greene0Benjamin G. Cobb1Ken F. Linnau2Christopher D. Kent3Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USADepartment of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USADepartment of Radiology, University of Washington School of Medicine, Seattle, WA 98195, USADepartment of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USABackground. 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.http://dx.doi.org/10.1155/2015/545902 |
| spellingShingle | Nathaniel H. Greene Benjamin G. Cobb Ken F. Linnau Christopher D. Kent Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement Anesthesiology Research and Practice |
| title | Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement |
| title_full | Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement |
| title_fullStr | Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement |
| title_full_unstemmed | Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement |
| title_short | Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement |
| title_sort | measurements of epidural space depth using preexisting ct scans correlate with loss of resistance depth during thoracic epidural catheter placement |
| url | http://dx.doi.org/10.1155/2015/545902 |
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