The impact of fluoroscopic confirmation of thoracic imaging on accuracy of thoracic epidural catheter placement on postoperative pain control

Figures & data

Figure 1 Selection and distribution of subjects.

Note: ^aCorrect level is defined as a difference of less than 2 vertebral segments between clinical and radiological assessments of catheter tips, whereas incorrect catheter placement is defined as differences of 2 or more vertebral levels between clinical and radiological assessment of catheter tips.

Figure 2 Degree of mismatch between clinical and radiological assessment.

Figure 3 Thoracic epidural catheter with contrast shown on the X-ray (A) and computed tomography (CT) scan (B).

Table 1 Demographic distribution of patients with incorrect versus correct catheter placement

Study characteristics	Incorrect placement Mean (±SD) (n=13)	Correct placement Mean (±SD) (n=9)	p-value
Age, years	58.00 (16.78)	58.33 (8.34)	0.957
Gender			0.79
Male	3	6
Female	10	3
BMI, kg/m^2	27.37 (3.59)	31.29 (7.26)	0.272
Procedure site			0.57
Thoracic	6	5
Abdominal	7	4
Difficulty of catheter insertion	2.8 (3.1)	3.8 (3.2)	0.6
Clinical level of epidural catheter	7.8 (1.6)	7 (1.1)	0.22
Radiological level of epidural catheter	10 (1.9)	7.3 (1.3)	<0.01

Abbreviation: BMI, body mass index.

Table 2 Incidence of catheter placement out of epidural space using landmark technique in previous studies

Study	Number of patients	Technique used	Type of study	Catheters placed out of epidural space
Parra et al^Citation20	53*	Fluoroscopy	RCT	26%
Uchino et al^Citation45	83	Fluoroscopy	Prospective	6%
Motamed et al^Citation15,Citation40	125	Computerized tomography	Prospective	24.8%

Note:

* Catheter placed out of epidural space using landmark technique.

Abbreviation: RCT, randomized control trial.

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