title: Thoracic epidural puncture guided by an acoustic signal: clinical results.
abstract: OBJECTIVE
  In previous studies we have demonstrated that it is possible and safe to identify the lumbar epidural space by an acoustic and visible signal. The use of an experimental set-up constructed for this purpose, the acoustic puncture assist device, the lumbar epidural puncture procedure became both audible and visible. In the present study we have extended the use of the device to localize the thoracic epidural space. We have also evaluated whether the device can be used as a practical tool to confirm correct catheter placement.
  
  
  METHODS
  In 100 consecutive patients a prototype of the acoustic puncture assist device was connected to the epidural needle in order to localize the epidural space. The device translates the pressure encountered by the needle tip into a corresponding acoustic and visible signal and enables the anaesthesiologist to detect the epidural space by means of the acoustic signal. After catheter insertion, local anaesthetic was administered. Subsequently the epidural block was tested. In 10 patients the device was also connected to the epidural catheter after its insertion into the epidural space.
  
  
  RESULTS
  In all 100 patients included in the study the epidural space was successfully located by means of the acoustic signal. The only recorded complication was intravascular catheter placement in two patients.
  
  
  CONCLUSIONS
  It is possible to localize the thoracic epidural space guided by an acoustic signal. The method was shown to be safe, reliable and simple. Potential implications of this technique include better needle control, improved monitoring for training purposes and for clinical documentation of the thoracic epidural puncture as well as identifying correct catheter placement.
authors.affiliation: Jeroen Bosch Ziekenhuis, Departments of Anaesthesiology and Pain Therapy, 's-Hertogenbosch, The Netherlands. t.lechner@home.nl
authors.forename: T J M
authors.initials: TJ
authors.lastname: Lechner
authors.forename: M G F
authors.initials: MG
authors.lastname: van Wijk
authors.forename: A J J
authors.initials: AJ
authors.lastname: Maas
authors.forename: F R C
authors.initials: FR
authors.lastname: van Dorsten
mesh_terms: D000162:Acoustics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009407:Nerve Block / Q000379:methods; D011312:Pressure; D011446:Prospective Studies; D013904:Thoracic Vertebrae; D013997:Time Factors