title: Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion.
abstract: OBJECTIVE
  Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations.
  
  
  METHODS
  Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups.
  
  
  RESULTS
  Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75],P= 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2],P= 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5],P= 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 sP= 0.00).
  
  
  CONCLUSIONS
  Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.
authors.affiliation: Department of Anesthesia, Kasr Alainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Hasanin
authors.affiliation: Department of Anesthesia, Kasr Alainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Mokhtar
authors.affiliation: Department of Anesthesia, Kasr Alainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Shereen M
authors.initials: SM
authors.lastname: Amin
authors.affiliation: Department of Anesthesia, Nasser Institute, Ministry of Health, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Sayed
keywords: Laparotomy; thoracic epidural; ultrasound