title: Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography.
abstract: BACKGROUND
  It may be clinically useful to predict the depth of the epidural space.
  
  
  METHODS
  To investigate the accuracy of preoperative abdominal computed tomography (CT) in prediction of the distance for low-thoracic epidural insertion, a single group observational study was conducted in 30 male patients undergoing elective major abdominal surgery requiring epidural analgesia for postoperative pain relief. Using the paramedian approach, low-thoracic epidural insertion at T10-11 interspace was performed with a standardized procedure to obtain an actual insertion length (AIL). According to the principles of trigonometry, an estimated insertion length (EIL) was calculated as 1.26 times the distance from skin to epidural space measured from the preoperative abdominal CT.
  
  
  RESULTS
  The mean (SD) EIL and AIL were 5.5 (0.7) and 5.1 (0.6) cm, respectively, with a significant correlation (r=0.899, P<0.01). The EIL tended to have a higher value than the AIL (0.4 (0.3) cm). There were significant correlations of both EIL and AIL with weight (P<0.01), BMI (P<0.01), and body fat percentage (P<0.01), but not with height (P>0.05).
  
  
  CONCLUSIONS
  We conclude that the preoperative abdominal CT is helpful in prediction of the distance for low-thoracic epidural insertion using the paramedian approach.
authors.affiliation: Department of Anesthesiology, Veterans General Hospital-Taipei, School of Medicine,National Yang-Ming University, Taipei, Taiwan.
authors.forename: M C
authors.initials: MC
authors.lastname: Kao
authors.forename: S K
authors.initials: SK
authors.lastname: Tsai
authors.forename: W K
authors.initials: WK
authors.lastname: Chang
authors.forename: H T
authors.initials: HT
authors.lastname: Liu
authors.forename: Y C
authors.initials: YC
authors.lastname: Hsieh
authors.forename: J S
authors.initials: JS
authors.lastname: Hu
authors.forename: M S
authors.initials: MS
authors.lastname: Mok
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D000886:Anthropometry; D004824:Epidural Space / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed