VAI TRÒ CỦA SIÊU ÂM TRỤC THẦN KINH TRONG GÂY TÊ NGOÀI MÀNG CỨNG ĐOẠN NGỰC

Abstract

Background: Identifying the intervertebral space in the thoracic region through palpation of anatomical landmarks has been challenging due to the characteristics of the overlapping spinous processes. Aim: The primary outcome was to determine the success rate of the first needle insertion in thoracic epidural anesthesia with ultrasound assistance. The secondary outcomes was to describe the ultrasoundmeasured depth from skin to epidural space, the actual depth of Tuohy needle and the angle of thoracic spinous processes. Methods: This cross-sectional study was conducted at Nhan Dan Gia Dinh Hospital. From November 2023 to May 2024, 30 patients undergoing elective surgery received thoracic epidural anesthesia had preprocedural ultrasound to examine pertinent spinal anatomy and determine the appropriate intervertebral space. Epidural anesthesia was performed at the marked location using the loss of resistance to saline technique. Results: The success rate of the first needle was 56.7%. The ultrasound-measured depth from skin to epidural space at the T5-T6 level was 3.4 cm and 4.5 cm in 2 cases, at the T7-T8 level was 3.9 ± 0.7 cm and at the T8-T9 level was 3.6 ± 0.6 cm. The actual depth of Tuohy needle at the T5-T6 level was 6 cm and 7 cm in 2 cases, at the T7-T8 level was 5.3 ± 0.8 cm and at the T8-T9 level was 5.0 ± 1.0 cm. The angle of the spinous processes at the T5-T6 level was 74° and 75° in 2 cases, at the T7-T8 level was 76 ± 3.4° and at the T8-T9 level was 77.5 ± 3.4°. Conclusions: In thoracic epidural anesthesia with the intervertebral space identified by ultrasound, the success rate of the first needle insertion was 56.7%. Preprocedural ultrasound provides supporting measurements for the thoracic epidural anesthesia.