Ultrasound assisted technique versus traditional blind technique for thoracic epidural block in abdominal operations

Abstract

Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However the data about the use of ultrasound in thoracic epidural block are scanty. In this study we have done a randomized controlled trial comparing pre-insertion ultrasound scanning with traditional manual palpation technique. Ultrasound has been recently used in guiding neuroaxial blocks. Both pre-procedural and real time ultrasound scanning were reported to improve the technique of neuroaxial blocks Pre-procedural ultrasound scanning was reported to provide reliable and accurate information on several critical aspects needed for successful epidural placement, such as the interspace level, the midline of the spine, the optimal puncture point, the optimal angle for needle insertion, and the depth of the ligamentum flavum- dura mater complex . Ultrasound was also helpful in determining the depth of subarachnoid space. This study designed to see the role of ultrasound examination of the back prior to thoracic epidural insertion. Forty eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. The patients were divided into two groups; Ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and control group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups. It was founded that Pre-procedural ultrasound imaging improved the ease of insertion of thoracic epidural catheters compared to manual palpation method.