Advertisement

Journal of Anesthesia

, Volume 26, Issue 2, pp 242–245 | Cite as

Utility of longitudinal paramedian view of ultrasound imaging for middle thoracic epidural anesthesia in children

  • Nobuko Tachibana
  • Masanori YamauchiEmail author
  • Shigekazu Sugino
  • Akihiko Watanabe
  • Michiaki Yamakage
Original Article

Abstract

Purpose

The risk of nerve injury for pediatric thoracic epidural block increases stress for anesthesiologists. The purpose of this study was to investigate the usefulness of longitudinal ultrasound imaging for thoracic epidural block (T5–T6 or T6–T7) in anesthetized children scheduled for the Nuss procedure.

Methods

Neuraxial structure in the longitudinal paramedian section was observed using ultrasound imaging before epidural puncture (US group, n = 10). In the control group, usual epidural block without ultrasound was performed. Attempts were made to observe epidural catheterization in ultrasound imaging in three cases.

Results

Patient age ranged from 5 to 7 years. Time for epidural block in the US group [100 (77–116) s; median value (95% confidence interval)] was significantly shorter than that in the control group [165 (130–206) s; P = 0.001]. The difficulty score was significantly lower in the US group than in the control group (P < 0.001). Epidural catheterization was observed in all three cases in which the catheter manipulated the dura mater ventrally. There was a high correlation (r = 0.98, P < 0.001) between needle depth and ultrasound estimation of the skin–dura distance in the US group.

Conclusion

We concluded that longitudinal paramedian ultrasound imaging could reduce performance time and the difficulty for anesthesiologists during epidural block.

Keywords

Children Longitudinal section Paramedian approach Thoracic epidural block Ultrasound imaging 

References

  1. 1.
    Tsui BC, Suresh S. Ultrasound imaging for regional anesthesia in infants, children, and adolescents: a review of current literature and its application in the practice of neuraxial blocks. Anesthesiology. 2010;112:719–28.PubMedCrossRefGoogle Scholar
  2. 2.
    Rapp HJ, Folger A, Grau T. Ultrasound-guided epidural catheter insertion in children. Anesth Analg. 2005;101:333–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Molik KA, Engum SA, Rescorla FJ, West KW, Scherer LR, Grosfeld JL. Pectus excavatum repair: experience with standard and minimal invasive techniques. J Pediatr Surg. 2001;36:324–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Weber T, Mätzl J, Rokitansky A, Klimscha W, Neumann K, Deusch E. Medical Research Society. Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair. J Thorac Cardiovasc Surg. 2007;134:865–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Kil HK, Cho JE, Kim WO, Koo BN, Han SW, Kim JY. Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children. Reg Anesth Pain Med. 2007;32:102–6.PubMedGoogle Scholar
  6. 6.
    Kawaguchi R, Yamauchi M, Sugino S, Tsukigase N, Omote K, Namiki A. Two cases of epidural anesthesia using ultrasound imaging. Masui. 2007;56:702–5.PubMedGoogle Scholar
  7. 7.
    Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Sitzwohl C, Kettner S, Kapral S. Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique. Br J Anaesth. 2006;97:200–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Carnie J, Boden J, Gao Smith F. Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion. Anaesthesia. 2002;57:701–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Marhofer P, Bösenberg A, Sitzwohl C, Willschke H, Wanzel O, Kapral S. Pilot study of neuraxial imaging by ultrasound in infants and children. Paediatr Anaesth. 2005;15:671–6.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Nobuko Tachibana
    • 1
  • Masanori Yamauchi
    • 1
    Email author
  • Shigekazu Sugino
    • 1
  • Akihiko Watanabe
    • 1
  • Michiaki Yamakage
    • 1
  1. 1.Department of AnesthesiologySapporo Medical University School of MedicineSapporoJapan

Personalised recommendations