Accuracy of the epidural catheter position during the lumbar approach in infants and children: a comparison among L2-3, L3-4, and L4-5 approaches.
BACKGROUND
The aim of this study was to compare the accuracy of the position of the epidural catheter inserted from three different lumbar intervertebral spaces, L2-3, L3-4, and L4-5, in infants and children.


METHODS
Seventy-five children were randomly allocated to 3 groups according to the epidural catheter insertion site (L2-3, L3-4, and L4-5). The epidural catheter tip was identified using 50% diluted Iohexol and fluoroscopy. The incidence of correct position was compared among the groups and between infants and children.


RESULTS
The incidence of correct position was significantly higher in the L2-3 group as compared to the L3-4 and L4-5 groups (P = 0.023 and P = 0.046 respectively). The incidence of correct position was higher in infants compared to children (P = 0.017).


CONCLUSIONS
The L2-3 intervertebral space is preferable during epidural catheter insertion in children older than 1 year, but a low lumbar level should be considered in infants because they have a higher risk of neural damage.
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yeon A
YA
Kim
Ji Young
JY
Kim
Hae Keum
HK
Kil
Eun-Mi
EM
Kim
Mi Kyeong
MK
Kim
Hye-Sung
HS
Kim