Garduño-López AL, Cruz-Yedra N, Díaz-Arizmendi DE, Verdugo-Velázquez FF, Acosta-Nava VM, Dominguez-Cherit G, Lugo-Goytia G, Macías-Rodriguez RU

Language: Spanish
References: 20
Page: 236-242
PDF size: 310.85 Kb.

ABSTRACT

Introduction: postoperative epidural analgesia in open abdominal or thoracic surgery remains the gold standard due to its advantages over intravenous opioid analgesia. However, the success of this technique relies heavily on the correct placement of the catheter in the epidural space. Being a blind, operator-dependent procedure, and in patients with diverse anatomical characteristics, there is a high incidence of placement failure ranging from 12% to 30%. In the immediate postoperative period with residual anesthetic effects, early detection of epidural catheter inefficacy due to misplacement outside the epidural space can be challenging, potentially leading to postoperative pain uncontrolled hours later. Multiple diagnostic methods have been proposed for catheter localization; however, many involve special devices that are costly, invasive, or impractical in the surgical setting like epidurography. Objective: to establish a sequence of steps for the adequate evaluation of the catheter in the epidural space using ultrasound. Material and methods: patients over 18 years of age scheduled for open abdominal or thoracic surgery candidates for thoracic epidural analgesia, who provided consent. Results: a total of 113 patients were included in the study. The mean age of the patients was 55.8 ± 15.2 years, with 50 (44.2%) being 63 (55.8%) female. The ultrasound-guided approach protocol was optimized through measurements with different patients. Conclusions: ultrasound emerges as a recent and promising diagnostic tool for locating the epidural catheter, utilizing both the M-mode and color Doppler mode. This protocol provides a solid foundation for future research, which will be able to analyze the diagnostic accuracy of ultrasound compared to epidurography, as well as evaluate its internal and external validity.

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