Ultrasound guided paramedian approach compared with landmark based paramedian approach for thoracic epidural

Introduction: Currently, one has to rely on surface anatomical landmarks and loss of resistance technique for epidural analgesia. It frequently (70%) leads to incorrect identification of a given inter-space as it is a blind technique. Therefore a better alternative technique is desirable. Aims and Objectives: To evaluate and compare ultrasound guided thoracic epidural technique with landmark-based thoracic epidural technique via paramedian approach. Materials and Methods: A study was done on 34 patients in each group with age ≥ 20 years, undergoing any major surgery, requiring thoracic epidural. The procedure and aim of the study was explained and a written informed consent was taken. Group 1 – (US group) – ultrasound guided thoracic epidural placement was done via paramedian approach .Group 2 – ((Landmark group) - landmark paramedian approach was done. The following parameters were studied – 1) Number of needle punctures and redirections through the same puncture site; 2) Number of attempts at catheter advancement; 3) Time taken for epidural catheter placement; 4) Pain felt by the patient during the procedure. The data was analysed using chi square test and student t test. Results: The number of needle punctures required, redirections and attempts of catheter advancement in both the groups were not statistically significant. The time required and pain felt for the procedure was significantly less in US Group as compared to Landmark group. Conclusion: US guided thoracic epidural technique via paramedian approach took less time for the procedure and was associated with less pain as compared to landmark approach.