Real-time ultrasound-guided thoracic epidural placement: Illustrating the techniques and reporting on prospective observational study

Background: This study aimed to assess the feasibility of real-time ultrasound-guided thoracic epidural placement. Methods: A prospective observational study was conducted in 20 patients undergoing elective abdominal and thoracic surgery. The procedure, performed with patients in a lateral position, involved three sequential steps: (1) identification of the interlaminar gap, (2) advancement of the Touhy needle, and (3) identification of the epidural space. Success was defined as the catheter insertion with achieving sensory blockade. The estimated and actual epidural depth, thoracic epidural placement success rate and procedural time were recorded. Results: The average age and body mass index were 62.1 ± 8.9 years and 22.4 ± 4.4 kg/m 2 . Thoracic epidural placement was successful in 18 patients (90%, 95% confidence interval: 77–100), and at first attempt in 12 of those (66.7%). The thoracic epidural placement times and total procedural time were 5 (4–6.75) min and 19.5 ± 5.4 min, respectively. The correlation between ultrasound-estimated epidural depth and actual depth was 0.81. Conclusion: Ultrasound guidance enhances thoracic epidural success rates and reduces attempts and skin punctures.