Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial
We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees. A cadaveric observational study and a clinical randomized controlled trial. Sapporo Medical University Hospital. A total of 52 adult p...
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| Veröffentlicht in: | Journal of clinical anesthesia 2025-02, Vol.101, p.111740, Article 111740 |
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| creator | Kunigo, Tatsuya Yoshikawa, Yusuke Niki, Shunichi Ohtani, Masahiro Muraki, Mami Nitta, Asako Ohsaki, Yuki Nagaishi, Kanna Yamakage, Michiaki |
| description | We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.
A cadaveric observational study and a clinical randomized controlled trial.
Sapporo Medical University Hospital.
A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.
Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).
The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.
Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87–158] vs 46 s [34–54] s, p |
| doi_str_mv | 10.1016/j.jclinane.2024.111740 |
| format | Article |
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A cadaveric observational study and a clinical randomized controlled trial.
Sapporo Medical University Hospital.
A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.
Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).
The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.
Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87–158] vs 46 s [34–54] s, p < 0.001 and 197 [156–328] vs 341 [303–488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263–467] s vs 391 [354–533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019).
Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.
•The most dorsal site of the transverse process root was identifiable by ultrasound.•The transverse process root was a reliable landmark of the interlaminar space.•We developed an innovative method for thoracic epidural catheter placement.•Our novel technique expedited needling among trainees.•Our novel technique enhanced success rates among trainees.</description><identifier>ISSN: 0952-8180</identifier><identifier>ISSN: 1873-4529</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2024.111740</identifier><identifier>PMID: 39752792</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Adults ; Aged ; Anatomic Landmarks ; Anesthesia ; Anesthesia, Epidural - methods ; Anesthesiology ; Cadaver ; Cadavers ; Catheterization - methods ; Catheters ; Clinical outcomes ; Clinical trials ; Epidural ; Epidural anesthesia ; Epidural catheter ; Epidural Space - diagnostic imaging ; Female ; Humans ; Hypotheses ; Male ; Middle Aged ; Observational studies ; Palpation ; Recovery (Medical) ; Skin ; Spinal Nerve Roots - anatomy & histology ; Spinal Nerve Roots - diagnostic imaging ; Success ; Surgery ; Thoracic Vertebrae - diagnostic imaging ; Time Factors ; Trainee ; Transverse process ; Ultrasonic imaging ; Ultrasonography, Interventional ; Ultrasound ; Visualization</subject><ispartof>Journal of clinical anesthesia, 2025-02, Vol.101, p.111740, Article 111740</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Feb 2025</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1882-25e52de0784980ccd0cbe14ca64975cb2942b94a9588904328b77f60111244a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0952818024003702$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39752792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kunigo, Tatsuya</creatorcontrib><creatorcontrib>Yoshikawa, Yusuke</creatorcontrib><creatorcontrib>Niki, Shunichi</creatorcontrib><creatorcontrib>Ohtani, Masahiro</creatorcontrib><creatorcontrib>Muraki, Mami</creatorcontrib><creatorcontrib>Nitta, Asako</creatorcontrib><creatorcontrib>Ohsaki, Yuki</creatorcontrib><creatorcontrib>Nagaishi, Kanna</creatorcontrib><creatorcontrib>Yamakage, Michiaki</creatorcontrib><title>Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.
A cadaveric observational study and a clinical randomized controlled trial.
Sapporo Medical University Hospital.
A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.
Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).
The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.
Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87–158] vs 46 s [34–54] s, p < 0.001 and 197 [156–328] vs 341 [303–488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263–467] s vs 391 [354–533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019).
Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.
•The most dorsal site of the transverse process root was identifiable by ultrasound.•The transverse process root was a reliable landmark of the interlaminar space.•We developed an innovative method for thoracic epidural catheter placement.•Our novel technique expedited needling among trainees.•Our novel technique enhanced success rates among trainees.</description><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Anatomic Landmarks</subject><subject>Anesthesia</subject><subject>Anesthesia, Epidural - methods</subject><subject>Anesthesiology</subject><subject>Cadaver</subject><subject>Cadavers</subject><subject>Catheterization - methods</subject><subject>Catheters</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Epidural</subject><subject>Epidural anesthesia</subject><subject>Epidural catheter</subject><subject>Epidural Space - diagnostic imaging</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Palpation</subject><subject>Recovery (Medical)</subject><subject>Skin</subject><subject>Spinal Nerve Roots - anatomy & histology</subject><subject>Spinal Nerve Roots - diagnostic imaging</subject><subject>Success</subject><subject>Surgery</subject><subject>Thoracic Vertebrae - diagnostic imaging</subject><subject>Time Factors</subject><subject>Trainee</subject><subject>Transverse process</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Interventional</subject><subject>Ultrasound</subject><subject>Visualization</subject><issn>0952-8180</issn><issn>1873-4529</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl1vFCEUhidGY2v1LzQk3ngzKzDMDuOVTeNX0sSbek0YOGtZGVg5zCbtP-6_8Gy39cIbExIIPO97OB9Ncy74SnCxfr9dbV0MySZYSS7VSggxKP6sORV66FrVy_F5c8rHXrZaaH7SvELccs7pQbxsTrpx6OUwytPm_kesxWJekm8tYsAKns3B-wis3uRiXXAMdsEvxUbmbL2BCoXtonUwQ6psqSGGu5B-Eg5szliZzwUJxlABWd6wKURLIrqiUAn3UBDYrmQHiKzkXJFZWsnWPAdHWLTJz7b8wg_sgmJ6SxL6Rp4Qyt7WkNPBvi7-llSeWXYoxYOS_D2Z3FESLqdacox0rCXY-Lp5sbER4c3jftZcf_50ffm1vfr-5dvlxVXrhNaylT300gMftBo1d85zN4FQzq4VFc1NclRyGpUde61Hrjqpp2HYrDk1QCplu7Pm3dGWEvy9AFYzB3QQKSfIC5pO9EL1XddLQt_-g27zUii3B2o96J4Pgqj1kXIlIxbYmF0JVJ1bI7g5zILZmqdZMIdZMMdZIOH5o_0yzeD_yp6aT8DHIwBUjn2AYtAFSA58KOCq8Tn8L8YfgpfOvQ</recordid><startdate>202502</startdate><enddate>202502</enddate><creator>Kunigo, Tatsuya</creator><creator>Yoshikawa, Yusuke</creator><creator>Niki, Shunichi</creator><creator>Ohtani, Masahiro</creator><creator>Muraki, Mami</creator><creator>Nitta, Asako</creator><creator>Ohsaki, Yuki</creator><creator>Nagaishi, Kanna</creator><creator>Yamakage, Michiaki</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>202502</creationdate><title>Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial</title><author>Kunigo, Tatsuya ; 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A cadaveric observational study and a clinical randomized controlled trial.
Sapporo Medical University Hospital.
A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.
Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).
The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.
Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87–158] vs 46 s [34–54] s, p < 0.001 and 197 [156–328] vs 341 [303–488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263–467] s vs 391 [354–533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019).
Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.
•The most dorsal site of the transverse process root was identifiable by ultrasound.•The transverse process root was a reliable landmark of the interlaminar space.•We developed an innovative method for thoracic epidural catheter placement.•Our novel technique expedited needling among trainees.•Our novel technique enhanced success rates among trainees.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39752792</pmid><doi>10.1016/j.jclinane.2024.111740</doi></addata></record> |
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| subjects | Adult Adults Aged Anatomic Landmarks Anesthesia Anesthesia, Epidural - methods Anesthesiology Cadaver Cadavers Catheterization - methods Catheters Clinical outcomes Clinical trials Epidural Epidural anesthesia Epidural catheter Epidural Space - diagnostic imaging Female Humans Hypotheses Male Middle Aged Observational studies Palpation Recovery (Medical) Skin Spinal Nerve Roots - anatomy & histology Spinal Nerve Roots - diagnostic imaging Success Surgery Thoracic Vertebrae - diagnostic imaging Time Factors Trainee Transverse process Ultrasonic imaging Ultrasonography, Interventional Ultrasound Visualization |
| title | Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial |
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