[Epidural catheterization dose not meet our expectation].

ABSTRACT

According to the roentgenographically confirmed intervertebral space at which an epidural catheter was placed, 241 patients who underwent abdominal or orthopedic hip surgery were allocated into 3 groups. Groups A, B, and C received epidural catheterization at Th7-10, Th10-L1, and L1-4, respectively. In each group, we examined the intervertebral space, which the anesthesiologist who had placed epidural catheter had determined, and the one which had been confirmed roentgenographically. We also investigated the catheter movement during the postoperative period. Catheters were barely placed at the same intervertebral space which had been confirmed roentgenographically. Considering the iliac crest as a landmark of L3-4 intervertebral space, the puncture point agreed with the roentgenographically confirmed intervertebral space with a percentage of 33 in group A. The extent of agreement increased up to 47 and 55 percent, in groups B and C, respectively. In contrast, when we counted down from the cervical prominent vertebra, a landmark of C7, the agreement was better in group A (55%) than in group C (33%). In the postoperative period, catheters came out more frequently in groups A and B than in group C, resulting from the early ambulation in abdominal surgery groups. There results suggest that, to place the epidural catheter more properly, (1) we should start to count from the landmark which is close to the puncture point and (2) we should keep it in mind that catheters come out accidently in patients who are encouraged to ambulate in the early postoperative period.