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REGIONAL ANESTHESIA

Three-Dimensional Computed Tomography for Difficult Thoracic Epidural Needle Placement

Hiroaki Murata, MD, PhD^*, Tetsuya Sakai, MD, PhD^*, Shinichi Goto, MD, PhD, and Koji Sumikawa, MD, PhD^*

From the *Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan; and Department of Anesthesia, the Japanese Red Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan.

Address correspondence and reprint requests to Hiroaki Murata, Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-City, Nagasaki 852-8501, Japan. Address e-mail to hiroaki_muramura{at}yahoo.co.jp.

BACKGROUND: Thoracic epidural anesthesia is often used as a postoperative analgesic technique in thoracic surgery. However, the structure of the overlapping spinous processes, resulting in interlaminar space occlusion, often makes thoracic epidural needle placement difficult. With the development of multi-detector row spiral computed tomography (CT), three-dimensional (3D) thoracic images can be readily obtained, providing potentially useful clinical information. Therefore, we conducted this study to evaluate the correlation between difficult thoracic epidural needle placement and anatomical findings obtained by 3DCT image processing techniques.

METHODS: Seventy-eight patients were studied. The number of new skin puncture attempts required for successful catheter insertion into the epidural space and the time spent during the procedure were recorded for each patient. The patients were defined as a first-level success when the needle placement was successful at the spinal level initially attempted. The others were defined as a first-level failure. The number of occluded mid-thoracic interlaminar spaces and the existence of mid-thoracic supraspinous and interspinous ligament ossification on the 3DCT images were also evaluated.

RESULTS: The percentage of first-level success was 84.6%. The number of occluded mid-thoracic interlaminar spaces was significantly greater in the first-level failure than in the first-level success (P < 0.001). The incidence of ossification of the mid-thoracic supraspinous ligament was significantly more frequent in first-level failure than in the first-level success (P = 0.001). The number of attempts and the time spent during the procedure significantly correlated to the number of occluded mid-thoracic interlaminar spaces (P < 0.001).

CONCLUSION: Preoperative 3DCT imaging may be useful in predicting difficult thoracic epidural needle placement.