Accuracy of the Thoracic Epidural Catheter Insertion Confirmed by Fluoroscopic Imaging

Determining the Accuracy of Thoracic Epidural Continuous Catheter Insertion With Confirmatory Fluoroscopic Imaging

In patients scheduled for thoracic surgery or upper abdominal surgery, investigators will determine the accuracy of the epidural catheter placement by using fluoroscopic imaging.

Previous studies have drawn contradictory conclusions based the potential flaw assumption of 100% success rate for correct epidural catheter placement in the thoracic region.

Thoracic epidural analgesia (TEA) is a key tool in management of pain after thoracic or upper abdominal surgery. TEA optimizes pain relief while minimizing the use of systemic opioids, thus reducing the duration of postoperative ileus. TEA also attenuates surgical stress response and allows for early mobilization. Despite all the touted benefits of TEA, much controversy limits its use for post surgical pain due to fear of exceedingly rare, if not entirely theoretical complication of epidural hematoma.

Beneficial effects of TEA require that catheter placement and infusate be targeted at the thoracic segments innervating injured skin, muscle, and bone from which pain input originates. The purpose of this study is to determine the accuracy of thoracic epidural continuous catheter insertion by using fluoroscopic imaging.

Inclusion Criteria:

• 18- 80 years old patients
• Patients undergoing thoracic surgery
• Patients undergoing upper abdominal surgery

Exclusion Criteria:

• Severe Aortic Valve stenosis
• Active Neurologic Disease
• Allergy to lidocaine or bupivacaine
• Allergy to iodine-based contrast
• Cutaneous Disorders at epidural insertion site
• Preoperative impaired coagulation status
• Pregnancy