A randomized controlled study comparing the use of ultrasound versus the conventional method in thoracic epidural catheter insertion as a pain relief method in thoracic surgeries

Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. The introduction of ultrasound technology for epidural insertion presents a novel challenge of acquiring new knowledge and skill set. As with acquiring any new skill, there will be initial challenges for both the novice and experienced anesthesiologist. From correlating anatomy with sonoanatomy and visualizing needles and fluid dynamics in real-time below the skin surface, ultrasound provides opportunities and unique challenges for vascular access and regional anesthesia. Purpose The purpose of this study was to evaluate the utility of ultrasound in the process of epidural catheter inserion and whether it can replace the conventional loss-of-resistance (LOS) technique or at least help with better performance by the staff. Patients and methods A total of 30 patients scheduled for thoracotomy were randomly categorized by closed envelopes method into two equal groups (15 patients each): group I patients received epidural anesthesia with ultasound guidance, and group II patients received epidural anesthesia with the conventional palpation technique. We recorded time from first puncture till LOS, number of skin punctures till LOS, redirections, and bone contacts. Failure and complications were recorded as well. Patient satisfaction was assessed after catheter insertion and removal, which was 24 h postoperatively in the postanesthesia care unit. Results A significant increase in insertion time was recorded in group I (P<0.001). The number of skin punctures till LOS was significantly lower in group I (P=0.043), and needle redirections were also lower in group I (P=0.020). Vertebrae were less hit by the needle in group I (P=0.026). A case of epidural failure was recorded in group II, and also an accidental hemorrhagic tap was recorded in the same group. Patient satisfaction both after catheter insertion and removal was higher in group I (P=0.031 and 0.002, respectively). Conclusion From the primary endpoints assessed in this work, one can declare that usage of ultrasound had consumed time owing to lack of experience by the operator, yet it led to less puncture attempts, redirections, and bone contacts and reduced failure rates and complication rates, which led to increased satisfaction. The technique requires more practice and training to familiarize anesthesia staff with it to lower the procedure time.