Pain
Conditions
Keywords
Thoracic epidural, Epidural anesthesia, Ultrasound, Palpation, Thoracic spine
Brief summary
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
Detailed description
• 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
Interventions
PROCEDUREUltrasound
Ultrasound-guided technique
PROCEDURELandmarking
Landmark-guided technique
Sponsors
Samuel Lunenfeld Research Institute, Mount Sinai Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years old. * Elective major abdominal or thoracic surgery requiring thoracic epidural anesthesia/analgesia. * Consent to participate and signed consent form.
Exclusion criteria
* Contraindication to epidural anesthesia. * Marked spinal deformities or a history of spinal instrumentation * Emergency surgery. * Inability to communicate in English. * BMI\>35 kgm-2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Needle redirections | 30 minutes | 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) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| New insertion point | 30 minutes | need to re-insert the epidural needle in the same interlaminar space, but using different insertion point |
| Number of insertions | 30 minutes | number of different interlaminar space insertions |
| Bony contacts | 30 minutes | number of bony contacts during the needle insertion |
| duration of epidural procedure | 30 minutes | duration of epidural procedure |
| complications during epidural insertion | 30 minutes | complications during epidural insertion |
| duration of ultrasound scanning | 30 minutes | duration of ultrasound scanning |
Countries
Canada
Outcome results
None listed