Korean J Pain.  2016 Oct;29(4):255-261. 10.3344/kjp.2016.29.4.255.

Analysis of thoracic epidurography and correlating factors affecting the extent of contrast medium spread

• Hong JH
• Oh JH
• Park KB

• KMID: 2354218
• DOI: http://doi.org/10.3344/kjp.2016.29.4.255

Abstract

BACKGROUND
Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography.
METHODS
A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread.
RESULTS
The mean number of vertebral segments evaluated by contrast medium was 7.9 ± 2.2 using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = −0.311, P < 0.05).
CONCLUSIONS
Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of 7.9 ± 2.2 spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium.

Keyword

Correlation; Distribution; Epidurography; Height; Spinal segment; Thoracic epidural anesthesia

MeSH Terms

Analgesia
Anesthesia, Epidural
Body Mass Index
Catheterization
Catheters
Epidural Space
Humans
Injections, Epidural

Figure

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  Fig. 1 Unilateral or bilateral epidural spread was checked through the anteroposterior fluoroscopic image (A) and the extent of contrast medium spread was assessed by evaluating the amount of contrast medium spread covering the vertebral body height through the lateral fluoroscopic image. Arrow indicates that contrast medium covers more than half of the vertebral body height (B).

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  Fig. 2 The number of spinal segments of cranial, caudad and total (both direction) spread of contrast medium. Cranial spread showed extensive distribution compated to caudad spread, and it was statistically significant (P < 0.01).

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  Fig. 3 Scatter plot showing the negative correlation of height (cm) and the extent of contrast medium spread during thoracic epidurography.

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