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Author(s) -
Chawathe M.S.,
Eickmann C.,
Harrison S.K.,
Jones R.M.,
Gildersleve C.D.
Publication year - 2002
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2002.10271_18.x
Subject(s) - medicine , catheter , epidural space , ultrasound , surgery , radiology
Occasionally we have found that post operative epidural infusions have failed to maintain adequate analgesia. This could be explained by the failure to thread the epidural catheter to the desired level. To date the only method described for imaging the catheter position is epidurography (1,2). This technique exposes the infant to unnecessary radiation. The aim of our study was to assess whether a non invasive imaging technique such as ultrasound could visualise the catheter in the epidural space. Method Following local ethics committee approval and informed consent a pilot study of 12 cases was performed. Children undergoing major surgery requiring epidural analgesia were recruited. All children were scanned within 24 hrs of epidural insertion by one of two consultant paediatric radiologists. The patients were positioned prone with knees flexed under the body to flex the spine. A Toshiba SSH 140A ultrasound machine with Linear 7.5 MHz probe was used to image the spine. If the catheter was identified in the epidural space then an attempt was made to visualise the entire length of the catheter. Discussion and Conclusion There was a significant learning curve with respect to identification of the catheter in the epidural space. The epidural catheter was visualised in 9 out of 10 children under the age of 6 months. It is not possible to image the catheter in older children (patients no. 1 and 2). It is not possible to precisely identify the tip of the catheter using ultrasound. However, the level of the tip was estimated at the point where the catheter was no longer visible. In 7 of the patients the tip was estimated to be in the thoracic region. It was usual to first see the catheter as it entered the epidural space and it was often seen alongside the canal rather than in its most posterior aspect. Ultrasound appears to be a reliable method for imaging the epidural catheter in children under 6 months of age and therefore can be of use in the clinical management of epidural analgesia, as well as a non invasive research tool.