Neuraxial Ultrasound for Thoracic Epidural Placement

Evaluation of Ultrasound-Assisted Thoracic Epidural Placement in Patients Undergoing Upper Abdominal and Thoracic Surgery: A Randomized, Double-Blind Study

This blinded, randomized study compares standard palpation to ultrasound-assisted landmark identification of the thoracic spine for thoracic epidural catheterization.

In this study, the investigators will utilize ultrasonography to identify midline bony landmarks including spinous processes, laminae, and intervertebral interspaces prior to the initial needle placement and compare this to standard palpation of the bony thoracic spine for thoracic epidural placement. The investigators will evaluate and compare the two needle localization techniques by the following outcomes: time to identify the epidural space by loss of resistance, needle passes, skin punctures, recovery room pain scores, and epidural success.

Inclusion Criteria:

• American Society of Anesthesiology Classification I-IV
• thoracic surgery
• abdominal surgery

Exclusion Criteria:

• contraindications to epidural catheter
• pregnancy
• coagulopathy
• infection (localized)
• allergy to local anesthetics